C-6: Transjugular Intrahepatic Portosystemic Shunt (TIPS)

• Post TIPS Orders
  1. Admit to ICU
  2. Strict bed rest - may elevate HOB
  3. Check VS (HR, BP, RR), check right IJ or EJ sheath for bleeding or hematoma, and check abdomen for peritoneal signs
     • q 15 min x 2, then
     • q 30 min x 4, then
     • q 1 hour if stable
  4. Call H/O and notify Interventional Radiology or radiologist on call for DBP < 60, or new abdominal pain or distention
  5. If bleeding or hematoma at puncture site occurs, elevate hob to 90 degrees, apply light manual compression, and call H/O
  6. Strict I/O
  7. Diet NPO x 24 hours - may have ice chips.
  8. Advance diet per H/O
  9. Right jugular sheath TKO
  10. IV fluids orders per H/O
  11. Resume other previous orders and medications.
  12. Ultrasound with Doppler study of portal vein post procedure and in a.m.
  13. If stable, D/C jugular sheath and transfer to floor following ultrasound exam in a.m.
  14. H/O to review and cosign these orders
• Recommended Doppler Follow-Up Post TIPS
  • Catheterize if Doppler suggests shunt malfunction
    • 24 hours
    • 1 week
    • 1 month
    • q 3-6 months

See Appendix B-27 for procedural information