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
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
- 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
- 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
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.
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.
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.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.Back to top
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.
- 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.
- 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
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.
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.
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.
- 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.
- 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.
- Examine the skin around the catheter. There should be no redness, open areas, or rash. Fluid should not leak around the catheter.
- 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.
- Gather your supplies. You will need:
- 1 (10 mL) prefilled normal saline syringe
- 2 alcohol wipes
- 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.
- 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.
- Sit or lie comfortably. Turn the stopcock toward the drainage bag (see Figure 4).
- Clean the needleless connector on the stopcock with an alcohol wipe for 15 to 30 seconds, rubbing vigorously.
- Place the syringe onto the needleless connector. Hold the connector while you push and turn the syringe clockwise to lock it into position.
- 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.