What to suspect if the drainage catheter has persistently elevated outputs?
If a catheter has persistently elevated outputs, a sudden increase in drainage, or a change in the composition of the effluent, a fistula should be suspected. Injection of contrast into the catheter under fluoroscopy often demonstrates the fistula, which can be to the gastrointestinal tract, pancreatic duct, biliary system, or to the genitourinary tract. Occasionally, an alternative study is necessary such as a small bowel follow-through if the fistula acts as a one-way valve and is not demonstrated by injection of the drainage catheter. Often the fistula will heal but prolonged drainage is required and can last as long as 2 to 4 weeks or more. The catheter should not be removed until the fistula has healed or has been repaired.