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Caring for Your Biliary Drainage Catheter

This information will help you prepare for having a biliary catheter (thin, flexible tube) placed and to care for it when you are at home.

Your Biliary System 

Bile is a liquid made by your liver that helps break down food. When your bile duct is narrowed or blocked by scar tissue or a tumor, bile can no longer flow into the first part of your small intestine, called the duodenum (see Figure 1). This causes the bile to collect in your liver. The build-up of bile in your liver can cause infection, nausea, vomiting, fever, itching, and jaundice (when the whites of the eyes and your skin look yellow). 

Figure 1. Narrow or blocked flow of bile Figure 1. Narrow or blocked flow of bile

There are 3 different ways a biliary catheter can drain the bile from your liver. Your doctor will discuss these with you before your procedure.

  • An external biliary drainage catheter goes through your skin and into your bile ducts. The end of the catheter that is in your bile ducts is placed above the blockage (see Figure 2). After this procedure you will have a catheter coming out of your body, attached to a drainage bag.

Figure 2. External biliary drainage catheter Figure 2. External biliary drainage catheter

  • An internal-external biliary drainage catheter goes through your skin and into your bile ducts, across the obstruction. 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 (see Figure 3). This catheter lets bile flow in 2 directions; out to the external collecting bag or into your small intestine. This is the most common kind of drainage catheter, however it is not always possible.

Figure 3. Internal-external biliary drainage catheter Figure 3. Internal-external biliary drainage catheter

  • Internal biliary drainage (stenting) uses a metal tube (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.

Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you. We have included some common examples below.
aspirin
tinzaparin (Innohep®)
prasugrel (Effient®)
warfarin (Coumadin®)
enoxaparin (Lovenox®)
dabigatran (Pradaxa®)
dalteparin (Fragmin®)
clopidogrel (Plavix®)
ticagrelor (Brilinta®)
heparin
cilostazol (Pletal®)
ticlopidine (Ticlid®)

Whether he or she recommends you stop taking it will depend on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.

  • If you take insulin or other medications for diabetes, you may need to change the dose before your procedure. Ask the doctor performing your biliary drainage catheter procedure what you should do the day before and the morning of your procedure.
  • Review the information in the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). It includes important information about medications you'll need to avoid before your procedure and what medications you can take instead.

If you’ve had an allergic reaction to contrast in the past, tell the doctor performing your biliary drainage catheter procedure. He or she may instruct you to take medication before your procedure.

Tell us if you're sick

If you develop any illness (fever, cold, sore throat, or flu) before your procedure, please call a nurse in Interventional Radiology at (212) 639-2236. A nurse is available Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call (212) 639-2000 and ask for the Interventional Radiology fellow on call.

Note the time of your appointment

A staff member from Interventional Radiology will call you 2 business days before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Thursday before. If you don't receive a call by 12:00 pm the business day before your procedure, please call (212) 639-5051.

If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.

The Day of Your Procedure

  • Do not eat anything after midnight the night before your procedure.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 8 ounces of clear liquids. This includes the liquids you will need to swallow any medications you were instructed to take the morning of your procedure. Examples of clear liquids include:
    • Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
    • Gelatin, such as Jello®
    • Clear fruit juices with no pulp, such as cranberry, grape, or apple
    • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
    • Coffee or tea, without milk or cream
  • Starting 2 hours before your scheduled arrival time, do not
    drink anything, including water. Do not chew gum or suck on
    any hard candies.

Things to remember

  • Take your medications the morning of your procedure as instructed by your doctor. Take them with a few sips of water.
  • Do not apply cream or petroleum jelly (Vaseline®). You can use deodorant and light moisturizers.
  • Do not wear eye makeup.
  • Remove any jewelry, including body piercings.
  • Leave all valuables such as credit cards and jewelry, at home.
  • If you wear contact lenses, wear your glasses instead, if possible. If you don’t have glasses please bring a case for your contacts.

What to bring with you

  • A list of the medications you take at home.
  • Medications for breathing problems (such as inhalers), medications for chest pain, or both.
  • A case for your glasses or contacts.
  • Your Health Care Proxy form, if you have completed one.
  • If you use a C-pap or Bi-pap machine to sleep at night, please bring your machine with you, if possible. If you can't bring your machine with you, we will give you one to use while you are in the hospital.

After Your Procedure

While you’re in the hospital

In the recovery room, your nurse will continue to monitor your pain, heart rate, breathing, and blood pressure. He or she will monitor your catheter site for any bleeding.

You will see the end of the catheter coming out of your body. It will be attached to a 3-way stopcock (see Figure 4). It is called a 3-way stopcock because it has 3 points of attachment and a tap that can be turned to control the flow. The drainage bag will be connected opposite the catheter. The final attachment point has a protective cover on it, called a needleless connector, such as a Microclave®. The Microclave® is clear.

Figure 4. 3-way stopcock Figure 4. 3-way stopcock

You will have a drainage bag attached to your catheter. You will see bile (yellow-green fluid) flowing into the bag. The fluid may appear bloody for the first day or 2. The color will eventually be golden yellow or greenish, depending on exactly where the catheter is inside your body.

While you’re in the hospital, your nurse will teach you and your caregiver how to care for the catheter. When you go home, you or your caregiver will inspect the catheter, flush the catheter twice each day, and empty the drainage bag at least once each day. Instructions for all of those steps are in this resource.

After you leave the hospital

The amount of fluid draining from your catheter may vary, however if you drain more than 500 mL in 1 day, talk with your doctor about what to drink to replace the fluid and salts that you are losing in the drainage.  As always, it is important to stay hydrated and eat a balanced diet. 

Once a week, you will need to change the dressing, stopcock, and drainage bag. You will need to change the dressing more often if it becomes loose, wet, or soiled. If a wet dressing is left against your skin, it may cause your skin to become red and sore. This makes skin breakdown more likely.

You may need help changing the dressing and drainage equipment. You will be able to inspect the catheter and flush the sterile normal saline yourself.

How to inspect your drainage catheter

Inspect your catheter every day using a hand held mirror, a full length mirror, or both.

Figure 5. Inspecting your catheter Figure 5. Inspecting your catheter

  1. Look at the position of the black mark. Make sure it is near the disk (see Figure 5). Your nurse will show you what to look for before you leave the hospital. If the black mark is not near the disk, call your doctor before you flush the catheter.
  1. Check the dressing to make sure that it is secure. If the dressing is wet, soiled, has come loose or started to pull away from the skin, it needs to be changed.
  2. Examine the skin around the catheter. There should be no redness, open areas, or rash. Fluid should not leak around the catheter.
  3. Look at the fluid in the bag. It should be flowing freely into the bag.  It should not have changed color or consistency. Check to make sure that the catheter is not kinked, and make sure the UC Strip® fastener is holding the catheter firmly. If you find a problem, call your interventional radiology nurse practitioner or fellow. The phone numbers are listed at the end of this resource.

How to flush your drainage catheter

You will need to flush your catheter with normal saline twice a day. Your doctor will tell you whether to use 3 mL, 5 mL, or 10 mL.

  1. Gather your supplies. You will need:
    • 1 (10 mL) prefilled normal saline syringe
    • 2 alcohol wipes
  2. Clean your hands. If you’re washing your hands with soap and water, wet your hands, apply soap, rub them together thoroughly for 15 seconds, then rinse. Dry your hands with a disposable towel, and use that same towel to turn off the faucet. If you’re using an alcohol-based hand sanitizer, be sure to cover your hands with it, rubbing them together until they’re dry.
  3. Take the syringe out of the wrapper. Remove the cap from the syringe using a twisting motion. With the cap off, remove the air from the syringe by holding the syringe open-side up and pushing the plunger slowly until the normal saline is at the top. If your doctor instructed you to flush with less than 10 mL, squirt the extra saline out before you connect the syringe. Lay the syringe on the table. Do not allow the tip of the syringe to touch anything.
  4. Sit or lie comfortably. Turn the stopcock toward the drainage bag (see Figure 4).
  5. Clean the needleless connector on the stopcock with an alcohol wipe for 15 to 30 seconds, rubbing vigorously.
  6. Place the syringe onto the needleless connector. Hold the connector while you push and turn the syringe clockwise to lock it into position.
  7. Push the plunger of the syringe to push 1/3 of the normal saline into the catheter, and then pause. Push in another 1/3 of the normal saline, and pause again.  Push in the rest of the normal saline into the catheter. Never pull back on the plunger. Always push forward.
If you have any of the following while flushing, do not try to put in any more saline. Stop and call your doctor’s office: 
  • Pain
  • Feel resistance
  • See leaking around the catheter

8.   When the syringe is empty, turn it counterclockwise to remove it. You can throw it away in your regular trash. Turn the stopcock back to the direction of the needleless connector (see Figure 4). You will probably see fluid drain into the bag.

How to change your Uresil dressing

The Uresil® dressing system is designed to help keep the catheter from moving out of the bile ducts. The disk is secured to your drainage catheter. The dressing covers the disk, which keeps the catheter in place.

The dressing, stopcock, and drainage system will need to be changed once a week. If the dressing gets wet, soiled, loose, or pulls away from your skin, change it. Although you may need the assistance of your helper to do the dressing and equipment changes, you can assemble the equipment yourself. Clean your hands, then gather the following supplies:
  • 1 Uresil adhesive dressing
  • Skin protectant
  • Adhesive remover wipe
  • Alcohol wipes
  • Plain gauze
  • Gauze moistened with soap and water
  • Non-sterile gloves
  • 1 (2 inch x 2 inch) Telfa®
  • Scissors
  • UC Strip® fastener
  • Wastebasket, if you choose

1.  Clean your scissors with an alcohol pad. If your Telfa is later than 2 inches by 2 inches, you will need to cut it to that size. Cut a slit in that piece and set it to the side. Sit or lie comfortably. At this point, you will need someone to help you. The person doing the dressing change should follow the instructions below.

2.  Clean your hands and put on nonsterile gloves.

3.  Put the drainage bag in a place where it will not fall.

4.  Hold the silicone disk in place using 1 finger to prevent tension or pulling on the catheter. Locate the slit in the Uresil® dressing. From this spot, slowly and gently peel the adhesive away from the skin while holding the disk. If the skin around the catheter is sensitive, wipe adhesive remover around the edge of the dressing to minimize discomfort.

5.  Loosen and remove the UC Strip® fastener as you pull the tape off.

6.  Dispose of the old Uresil® dressing.

7.  Use a gauze pad moistened with soap and water to clean the skin around and under the disk. Using the same gauze, clean the top and bottom sides of the silicone disk itself. Always hold one side of the disk firmly on the skin while cleaning under the other side.

8.  Rinse and dry the skin and the silicone disk with fresh gauze.

9.  Wipe the top side of the silicone disk with an alcohol wipe. This removes any soap residue.

10.  Look at the disk nipple. The black ink mark should be just above the disk nipple (see Figure 5). If it moved, finish changing the dressing, and then call your doctor’s office.  Inspect the insertion site under the silicone disk. Always hold one side of the disk firmly on the skin while tilting up the other side.  If you see any of the following, finish changing the dressing and call your doctor’s office:
  • Redness
  • Swelling
  • Foul-smelling drainage
  • Leakage of fluid

12.  You may notice new tissue growing around the insertion site. This is harmless, but it can be removed by your doctor if it is painful.

13.  Apply the no sting barrier film to the skin around the silicone disk. Then apply more to the top of the disk where the dressing will be placed. This protects your skin and helps the adhesive stick better.

14.  Slide the Telfa® under the disk, around the catheter (see Figure 6). The slit should point towards the patient’s feet. The Telfa® will prevent moisture from building up under the disk.

Figure 6. Telfa® Figure 6. Telfa®

15.  Pick up the Uresil® dressing.  Open the slit and place it around the catheter (see Figure 7). Line the slit up with the slit in the Telfa®. Make sure the dressing is adhesive side down, shiny side up. Place the dressing over the flat part of the disk, but under the disk’s nipple. The slit in the dressing should point towards the patient’s feet.

Figure 7. Uresil® dressing Figure 7. Uresil® dressing

16.  The Uresil® dressing has 3 pieces of backing. Start at the corner of the biggest piece and slowly peel the backing away. As you peel away the paper, press the adhesive to the skin. This will get easier with practice. If the dressing does not stick properly, remove the Uresil® dressing and Telfa® and restart at step 13.

17.  Remove the other 2 pieces of backing paper 1 at a time. Press the adhesive to the skin. Overlap the slit edges of the dressing to make the dressing more secure. If you are only changing the dressing, change the UC Strip® fastener at this time. This will make the catheter more secure.

18.  Remove your gloves and discard them in the wastebasket.

19.  Write date of dressing change on the Uresil® dressing so that you know when to change it again.

20.  Clean your hands.

How to change the stopcock and drainage equipment

1.  Gather your equipment:

  • Nonsterile gloves
  • 1 needleless connector
  • 1 sterile 3-way stopcock
  • 1 drainage bag
  • 1 UC Strip® fastener
  • Safety pin or strap

2.  Clean your hands.

3.  Open the packages containing the needleless connector, 3-way stopcock, and drainage bag. Save the package from the drainage bag.

4.  Clean your hands again.

5.  Remove the protective cover from the base of the needleless connector.  Attach the needleless connector to center port of the stopcock (see Figure 4).

6.  Connect the tubing from the drainage bag to the stopcock with a twisting motion. Close the blue drainage port on the bottom of the bag by turning it clockwise. Closing the port prevents leaking.

7.  Place the assembled drainage bag back in its package. This will keep it clean until you are ready to connect it to the catheter.

8.  Put on non-sterile gloves.

9.  If you have not done so, loosen and remove the old UC Strip® fastener.

10.  If the bag is attached with a safety pin, remove the safety pin. Make sure the new drainage bag is within your reach.

11.  While holding gauze under the connector, twist off the old stopcock and drainage system from the catheter and discard. Quickly attach the new stopcock and drainage system.

12.  Make sure the off tap of the stopcock is turned in the direction of the needleless connector.

13.  Secure the new tubing to the abdomen with a UC Strip® fastener:

  • Remove the backing from the center of the UC Strip® fastener to expose the adhesive (see Figure 8).

Figure 8. UC Strip® fastener Figure 8. UC Strip® fastener

  • Place the center section of the adhesive onto the drainage bag tubing about 2 to 4 inches down from stopcock.
  • Press the adhesive around the drainage bag tubing (see Figure 9). The remaining adhesive will stick together.

Figure 9. Securing UC Strip® fastener to tubing Figure 9. Securing UC Strip® fastener to tubing

  • Select a position for the UC Strip® fastener.  The UC Strip® fastener and drainage bag tubing should be lower than the catheter insertion site. Rest the tubing on the abdomen on the selected site. There should be no pull or tension on the catheter.  You should see a gentle bowing of the catheter.
  • Remove the backing paper from each side of the UC Strip® fastener, one at a time. Smooth the adhesive onto the abdomen. The UC Strip® fastener will prevent pulling, tension, or kinking of the drainage catheter and tubing (see Figure 10).

Figure 10. Securing UC Strip® fastener to skin Figure 10. Securing UC Strip® fastener to skin

14.  Secure the drainage bag with the strap or with a safety pin. You can attach the bag to the waistband of your clothing with the safety pin or to your leg with the attached Velcro straps. The bag should be below the level of the catheter. That allows the catheter to drain by gravity (see Figure 11).

Figure 11. Drainage bag must be below the catheter Figure 11. Drainage bag must be below the catheter

15.  Check to see that the catheter is draining into the new tubing.

16.  When you have finished, remove your gloves and clean your hands.

Sign and Symptoms of Blockage

The following signs and symptoms that may mean your drainage catheter is blocked.

  • Decreased amount or absence of bile
  • Persistent leakage of bile around the insertion site
  • Inability to flush catheter
  • Leaking around catheter during flushing
  • Temperature higher than 100.4° F (38° C) and/or chills
  • Nausea
  • Increased jaundice
  • Pain

If you have any of the signs or symptoms above, check your catheter first by doing the following:

  • The black ink mark should be located slightly above the nipple of the disk. If it is not, the catheter may have moved out of the bile duct.
  • If the black mark has not moved, check the position of the tap on the 3-way stopcock. Make sure it is pointing in the direction of the needleless connector.
  • Remove any kinks in the tubing since they can stop the flow into the drainage bag.
  • If there is still no drainage, gently flush the catheter with the amount of normal saline you usually use. Stop instillation if you have:
    • Pain
    • Resistance
    • Leakage around the catheter

If you still have any of the symptoms above after checking your catheter, call the nurse or fellow at the numbers listed at the end of this resource.

If you have a fever of 100.4º F (38º C) and you have no symptoms of blockage, call your primary doctor at MSK.

Notify the nurse or fellow in Interventional Radiology if:

  • The location of the black mark has changed
  • The clamp around disk is loose or opened
  • If the stitch is broken (if your catheter is stitched in place)
  • Your skin looks red or irritated
  • Drainage fluid is leaking around the catheter
  • There is no longer drainage from the catheter
  • There is a kink in the tube that you cannot straighten out, causing a blockage in the flow
  • You have pain, tenderness, or swelling at the catheter site
  • You have fever
  • You experience pain, resistance, or leakage around catheter when instilling normal saline
  • You notice a bloody appearance to your drainage
  • You have any concerns about your catheter

Routine Change of Your Biliary Drainage Catheter

Biliary drainage catheters are usually changed every 8 to 12 weeks. Your interventional radiologist may tell you to come in more or less frequently. You can make you own appointment for a routine catheter change. Call (212) 639-7946 at least 3 weeks ahead of time to make an appointment.

Special Points to Remember

The catheter can be easily covered by clothing. You may go to work and exercise with the catheter in place. Avoid movements that involve aggressive stretching from side to side or continual bending. These could dislodge the catheter. You may not swim with your catheter. Speak to the radiologist if you have a warm weather vacation planned so that you can be taught what to do in this situation.

You may take showers. Remove the belt and empty the drainage bag. Tape the drainage bag to your abdomen. If you plan to change your dressing right after your shower, you do not have to cover it.  If you will be not change your dressing, tape plastic wrap or a gallon sized bag over the dressing to keep it dry. If the dressing gets wet despite covering it, you will need to change it. Wet dressings are the major cause of skin problems. A hand held shower can help direct the water away from the dressing.

Keep the tubing secured to your body with a UC Strip® fastener at all times.  When you are getting dressed, take care not to tug on the catheter. Do not allow the tubing to become kinked by clothing such as pantyhose or a belt.  Try not to lie on your catheter when you sleep.  This will prevent kinking of the catheter.

A Visiting Nurse Service referral will be made for you before you leave the hospital. Your visiting nurse will assist you and your caregiver until you can manage the catheter care on you own. This may be just 1 or 2 visits.

Inspect the bile frequently. It should be flowing freely into the bag.  It should always look the same. If there is a decrease in amount, or if the bile color or sediments change, you may not be drinking enough fluids.

Special instructions for internal/external biliary drainage catheters

If you have an internal-external biliary drainage catheter, your doctor may want you to do a capping trial. A needleless connector is put on the end of the catheter and you will no longer need a bag. This is done to see if all of the bile can drain into your digestive system.

If you have a capped internal-external drainage catheter, you need to attach the catheter to a bag (assembled as instructed above) if you have any of the following:

  • Pain
  • Fever
  • Leaking around the catheter
  • Inability to flush the catheter

Be sure to remove needleless connector on the catheter before attaching to a bag. This will let the bile flow out externally.

Call the nurse or fellow at the numbers listed at the end of this resource.

Ordering Information

If you order supplies from General Stores at MSK, you will need to come to MSK to pick them up. You can also order directly from the company. You will need a prescription to obtain pre-filled normal saline syringes. If your local pharmacy cannot supply the syringes, you can get these from the outpatient pharmacy at MSK.

Item

MSK Number

Supplied

Adhesive remover

3170

box

Alcohol wipes

3330

box

Drainage Discharge Kit

(4 weeks of supplies)

3115

kit

Needleless connector

9697

each

Microfoam

3316

box

Micropore paper tape

4326

box

Non-sterile latex gloves

4860

box

Plain gauze

3424

package

Skin Prep

3332

box

Telfa

3327

each

Three Way Stopcock (Cook brand)

5192

each

Uresil® drainage bag

3361

each

Uresil® adhesive dressing

3226

box

UC Strip® catheter tubing fastener

2676

box

Contact Information

If you have any questions or concerns, please call Interventional Radiology at (212) 639-2236. You can reach a staff member Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, please call (212) 639-2000 and ask for the fellow on call for Interventional Radiology.