Biliary Drainage Catheter Home Guide Instructions

A biliary drainage catheter is a thin, flexible tube that is inserted through your skin into the bile ducts in your liver. Bile is a thick yellow or green fluid that helps digest fat in foods.

The purpose of a biliary drainage catheter is to keep bile from backing up into your liver. Backup of bile can occur when there is a blockage that prevents bile from moving from the bile ducts into the small intestine as it should.

If your bile duct is blocked, your doctor may recommend that you have a biliary drainage catheter placed. This will allow the bile to drain from your liver.

There are 3 different ways bile can be drained from your liver. Your doctor will discuss these with you before your procedure.

1. An external biliary drainage catheter goes through your skin and into your bile ducts. It will be placed above the blockage. After this procedure you will have a catheter coming out of your body, attached to a drainage bag.
2. An internal-external biliary drainage catheter goes through your skin and into your bile ducts, across the blockage. One end of the catheter will sit in your small intestine, and the other will come out of your body and will be attached to a drainage bag. This catheter lets bile flow in 2 directions, either out to the external collecting bag or into your small intestine. This is the most common kind of drainage catheter, but not everyone is able to get this type.
3. Internal biliary drainage (stenting) uses a metal cylinder (called a stent) to hold the blocked area open. After this procedure you may have a small catheter coming out of your body. If you have a catheter, you will return to Interventional Radiology later the same day or the following day so your doctor can see if the stent is working well. If it is, the catheter will be removed.

The blockage can be caused by gallstones, a tumor, or scar tissue. There are three types of biliary drainage:

• External biliary drainage. With this type, bile is only drained into a collection bag outside your body (external collection bag).
• Internal-external biliary drainage. With this type, bile is drained to an external collection bag as well as into your small intestine.
• Internal biliary drainage. With this type, bile is only drained into your small intestine.

General home care includes these daily actions:

• Inspection of your drainage catheter.
• Flushing your drainage catheter with saline.
• Emptying drainage from the collection bag (if present).
• Recording the amount of drainage.

Checking the catheter insertion site for signs of infection. Check for:

• Redness, swelling, or pain.
• Fluid or blood.
• Warmth.
• Pus or a bad smell.

How do I inspect my drainage catheter?

• Check the dressing to make sure that it is dry and clean.
• Look at the skin around the drainage catheter when changing the dressing for any problems such as redness, rash, or skin breakdown.
• Check the drainage bag to make sure that drainage fluid is flowing into the bag well. Note the color and amount compared to other days.
• Check the drainage catheter and bag for any cracks or kinks in the tubing.

How do I change my dressing?

The dressing over the drainage catheter should be changed every other day, or more often if needed to keep the dressing dry. Your health care provider will instruct you about how often to change your dressing.

Supplies needed:

• Mild soap and warm water.
• Split gauze pads, 4 x 4 inches (10 x 10 cm) to use as a dressing sponge.
• Gauze pads, 4 x 4 inches (10 x 10 cm) or adhesive dressing cover.
• Paper tape.

How to change the dressing:

1. Wash your hands with soap and water.
2. Gently remove the old dressing. Avoid using scissors to remove the dressing because they may damage the drainage catheter.
3. Wash the skin around the insertion site with mild soap and warm water, rinse well, then pat the area dry with a clean cloth.
4. Check the skin around the drainage catheter for redness or swelling, or for yellow or green discharge that has a bad smell.
5. If the drainage catheter was stitched (sutured) to the skin, inspect the suture to make sure it is still anchored in the skin.
6. Do notapply creams, ointments, or alcohol to the site. Allow the skin to air-dry completely before you apply a new dressing.
7. Place the drainage catheter through the slit in a dressing sponge. The dressing sponge should slide under the disk that holds the drainage catheter in place.
8. Cover the drainage catheter and the dressing sponge with a 4 x 4 inch (10 x 10 cm) gauze. The drainage catheter should rest on the gauze and not on the skin.
9. Tape the dressing to the skin.
10. You may be instructed to use an adhesive dressing covering over the top of this in place of the gauze and tape.
11. Wash your hands with soap and water.

How do I flush my drainage catheter?

Biliary drainagecatheters should be flushed daily, or as often as told by your health care provider. The end of the drainage catheter is closed using an IV cap. A syringe can be directly connected to the IV cap.

Supplies needed:

• Alcohol swab.
• 10 mL prefilled normal saline syringe.

How to flush the drainage catheter:

1. Wash your hands with soap and water.
2. If your drainage catheter has a stopcock attached to it, turn the stopcock toward the drainage bag. This will allow the saline to flow in the direction of your body.
3. Clean the IV cap with an alcohol swab.
4. Screw the tip of a 10 mL normal saline syringe onto the IV cap.
5. Inject the saline over 5–10 seconds. If you feel resistance while injecting, stop immediately. Avoid pulling back on the plunger. Doing that could increase your risk of infection.
6. Remove the syringe from the cap. Turn the stopcock so that fluid flows from your body into the drainage bag. You may notice more fluid flowing into the bag after you have completed the flush.

How do I attach a bag to my drainage catheter?

If you are having trouble with your internal biliary drain, you may be directed by your health care provider to use bag drainage until you can be seen to fix the problem. For this reason, you should always have a collection bag and connecting tubing at home. If you do not have these supplies, remember to ask for them at your next appointment.

1. Remove the bag and the connecting tubing from their packaging.
2. Connect the funnel end of the tubing to the bag’s cone-shaped stem.
3. Remove the IV cap from the biliary drain. To do this, unscrew it and replace it with the screw-on end of the tubing.
4. Save the IV cap in a plastic storage bag that can be sealed.

How do I empty my collection bag?

Empty the collection bag whenever it becomes 2/3 full. Also empty it before you go to sleep. Most collection bags have a drainage valve at the bottom so the bag can be that allows them to be emptied easily.

1. Wash your hands with soap and water.
2. Hold the collection bag over the toilet, basin, or collection container. Use a measuring container if your health care provider told you to measure the drainage.
3. Unscrew the valve to open it, and allow the bag to drain.
4. Close the valve securely to avoid leakage.
5. Use a tissue or disposable napkin to wipe the valve clean.
6. Wash the measuring container with soap and water.
7. Record the amount of drainage as told by your health care provider.

Contact a health care provider if:

• Your pain gets worse after it had improved, and it is not relieved with pain medicines.
• You have any questions about caring for your drainage catheter or collection bag.
• You have any of these around your catheter insertion site or coming from it:
  • Skin breakdown.
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth to the touch.
  • Pus or a bad smell.

Get help right away if:

• You have a fever or chills.
• Your redness, swelling, or pain at the catheter insertion site gets worse, even though you are cleaning it well.
• You have leakage of bile around the drainage catheter.
• Your drainage catheter becomes blocked or clogged.
• Your drainage catheter comes out.

Biliary Drainage Catheter Placement

A biliary drainage catheter is a thin, flexible tube that is inserted through the skin into the bile ducts in the liver.

This is sometimes called a percutaneous transhepatic biliary drainage catheter. Bile is a thick yellow or green fluid that helps digest fat in foods.

The purpose of a biliary drainage catheter is to keep bile from backing up into the liver. Backup of bile can occur when there is a blockage that prevents bile from moving from the bile ducts into the small intestine as it should. The blockage can be caused by gallstones, a tumor, or scar tissue.

There are three types of biliary drainage:

• External biliary drainage. With this type, bile is only drained into a collection bag outside the body (external collection bag).
• Internal-external biliary drainage. With this type, bile is drained to an outside collection bag as well as into the small intestine.
• Internal biliary drainage. With this type, bile is only drained into the small intestine.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Damage to other structures or organs, such as the liver, bile ducts, intestines, or stomach.
• A bile leak.
• Allergic reaction to the dye that is used to guide placement of the catheter.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your normal medicines. This is especially important if you take diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your doctor tells you not to.

General instructions

• You may have blood tests, such as tests that can show:
  • How well your kidneys and liver are working.
  • How well your blood can clot.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins. You may be given medicine through this tube to help prevent nausea, pain, or infection.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• The biliary drainage catheter will be inserted into a needle.
• The needle will be inserted into your body and guided to your bile duct. A type of X-ray (fluoroscopy) will be used to guide the needle.
• Depending on which type of biliary drainage catheter is inserted, the catheter may be advanced to your small intestine.
• A dye will be injected through the catheter. This will make your bile ducts easier to see in X-rays that will be taken.
• The catheter will be left in place with a stitch (suture) that will be placed into your skin and around the tube.
  • If an external or internal-external biliary drainage system is inserted, the catheter will exit your body and will be connected to a collection bag.
  • If an internal biliary drainage system is inserted, the catheter exiting your body will remain in place for a short time until the location of the draining system is confirmed by X-ray. The catheter will be removed after the placement of the biliary drainage system is confirmed.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have discomfort at the drainage site. You will be given pain medicines to control the pain.
• You will need to remain lying down for several hours, or as told by your health care provider.
• You will be instructed about how to empty and care for the drainage catheter and collection bag.
• Do notdrive for 24 hours if you were given a sedative.

Care After Biliary Drainage Catheter Placement

What can I expect after the procedure?

After the procedure, it is common to have:

·         Pain or soreness at the catheter insertion site.

·         Tiredness and sleepiness for several hours.

·         Some bruising at the catheter insertion site.

·         Drainage into the collection bag on the outside of your body, if you have an external drainage catheter.

o    You might see bloody discharge in the bag for the first 1 or 2 days.

o    Then, the discharge should turn a yellow-green color.

Follow these instructions at home:

Medicines

·         Take over-the-counter and prescription medicines for pain, discomfort, or fever only as told by your health care provider.

·         Do not take aspirin or blood thinners unless your health care provider says that you can. These can make bleeding worse.

·          

Do notdrive or use heavy machinery while taking prescription pain medicine.

Catheter insertion site care

·         Clean the catheter insertion site as told by your health care provider.

·         Do not take baths, swim, or use a hot tub until your health care provider approves.

·         Take showers only. Before showering, cover the catheter insertion area with a watertight covering to keep the area dry.

·         Keep the skin around the catheter insertion site dry. If the area gets wet, dry the skin completely.

·         Check your catheter insertion site every day for signs of infection. Check for:

o    Redness, swelling, or pain.

o    Fluid or blood.

o    Warmth.

o    Pus or a bad smell.

General instructions

·         Rest for the remainder of the day.

·         Do notdrive, use machinery, or make legal decisions for 24 hours after your procedure.

·         Resume your usual diet. Avoid alcoholic beverages for 24 hours after your procedure.

·         Keep all follow-up visits as told by your health care provider. This is important.

·          

Drink enough fluid to keep your urine clear or pale yellow.

Contact a health care provider if:

·         Your pain gets worse after it had improved, and it is not relieved with pain medicines.

·         You have any questions about caring for your drainage catheter or collection bag.

·         You have any of these around your catheter insertion site or coming from it:

o    Skin breakdown.

o    Redness, swelling, or pain.

o    Fluid or blood.

o    Warmth to the touch.

o    Pus or a bad smell.

Get help right away if:

·         You have a fever or chills.

·         Your redness, swelling, or pain at the catheter insertion site gets worse, even though you are cleaning it well.

·         You have leakage of bile around the drainage catheter.

·         Your drainage catheter becomes blocked or clogged.

·         Your drainage catheter comes out.

 

Biliary drainage procedures are associated with significant catheter-related complications, occurring in up to 22% of procedures.

Complications affecting catheter function include pericatheter leakage, catheter obstruction, postclamping cholangitis, catheter obstruction, and catheter dislodgement/malposition.

Percutaneous Biliary Drainage Obstruction

PBD catheter obstruction is usually the result of bile stones, biliary sludge, blood clots, or intestinal debris. Daily flushing of the catheter with saline can help prevent obstructive episodes.

Signs of PBD obstruction include rising serum bilirubin levels, right upper quadrant pain, fever, leukocytosis, jaundice, pruritus, nausea, abrupt decrease in catheter output (for those on external drainage), resistance with flushing, and/or pericatheter leakage. If any of these findings are encountered, catheter obstruction must be considered and promptly addressed.

Since the presence of a PBD across the sphincter of Oddi results in biliary colonization with intestinal bacteria, obstruction of the catheter (and biliary tree) can rapidly result in cholangitis and progress to sepsis if not recognized and addressed in a timely fashion.

Cholangiography via the PBD catheter can demonstrate patency of the catheter and side holes; however, partial obstruction can be difficult to ascertain.

Therefore, empiric catheter exchange is commonly performed in the setting of signs or symptoms that suggest the possibility of PBD obstruction.

If catheter exchange plus empiric antibiotics do not mitigate these signs or symptoms, a search for an alternative cause is warranted.

In cases of recurrent obstruction, PBD upsizing to 12 or 14 French (or larger) may be helpful. In rare cases, catheter kinking or an excessively tight skin anchoring suture may be the cause of catheter obstruction.