Pre-op Preparation - These patients will most likely have severe cirrhosis and coagulation issues. Check coag labs (PT, PTT, INR), have platelets and FFP available if needed. Coagulation abnormalities should be treated and resolved before the procedure. Off-site - These procedures are typically done in Interventional Radiology (IR) or cath lab Lines - Have an 18g IV in case you need to transfuse blood. an A-line should be strongly considered (and generally recommended) especially if hemodynamically unstable and/or anticipated high blood loss. Approach - GETT is usually standard with TIPS, most surgeons want the patient to be paralyzed due to the high risk of bleeding if a vessel in the liver is perforated due to unexpected movement/bucking. MAC/Local could be used if necessary (eg. respiratory issues). Circuit extension - If taking the GETT approach, the circuit will need to be out of the surgical field. Have an extension and drape it from the chest/abdomen up to the patient's airway.
A transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous interventional radiological procedure that creates a connection within the liver between the portal and systemic circulations. A TIPS procedure is typically done for patients with severe liver failure causing life threatening variceal bleeding. In most cases this is a last ditch effort to decrease portal pressure by bypassing the liver with a shunt passed through the liver to the systemic circulation.
