Use of transjugular intrahepatic portosystemic shunt in liver disease

Persons with cirrhosis have many complications. Two of these complications are refractory ascites and recurrent gastrointestinal hemorrhage. When medical management has proved ineffective in the management of these two complications, a transjugular intrahepatic portosystemic shunt can be a treatment option. This outpatient procedure can reduce ascites, minimize the need for diuretics, and reduce the potential for gastrointestinal hemorrhage. The procedure is associated with the development of hepatic encephalopathy, which requires vigilant nursing observation. Education of the patient and family regarding the potential development of encephalopathy and the need for follow-up by the physician is important. The collaboration of physicians and nurses in the ongoing monitoring and follow-up of these patients can contribute to an improved quality of life and reduced hospitalizations. Nurses play an important role in alerting physicians to changes in patient condition that might indicate a narrowing of the transjugular intrahepatic portosystemic shunt, which requires intervention. (J Vasc Nurs 2000;18:83-7)