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Biliary Tube Care Instructions
WHAT IS A BILIARY DRAINAGE CATHETER?
A biliary catheter is a small flexible, rubber tube placed into the common bile duct, the passageway for the bile to flow from the gallbladder and liver to the duodenum (small intestine, also referred to as the bowel). The catheter can drain the bile either internally (inside your intestines) or externally (into a bag outside your body). Bile is a thick fluid, usually golden yellow in color.
WHY DO I NEED A BILIARY DRAINAGE CATHETER?
1. You may have a blockage of the bile ducts, causing the bile to back up into your liver.
2. There may be a hole in the bile duct causing bile to leak.
3. To prepare for surgery or for some other procedure on your bile ducts, such as removal of a stone or tumor.
HOW DO I PREPARE FOR THE PROCEDURE?
If you are already a patient in the hospital, your doctors and nurses will provide you instructions. If you are to be admitted to the hospital after this procedure, please follow these listed instructions:
1. No solid food after midnight. You may have clear liquids.
2. Take your medications as usual. If you are on glucophage, insulin, or a blood thinner, contact our department as soon as possible so we can adjust the dosage of your medications.
3. If you are allergic to x-ray or contrast dye, notify our department ASAP, so that necessary precautions can be undertaken.
4. Bring all your medications with you on the day of the procedure.
WHAT HAPPENS BEFORE THE PROCEDURE?
1. The nurse and interventional radiologist will talk with you about the procedure in detail, answer your questions, and ask you to sign a consent form.
2. You will be asked to put on a hospital gown, and remove anything metal, such as jewelry or false teeth/dentures.
3. Your family or significant other will be asked to go to our designated waiting area.
4. An IV will be started for fluids, antibiotics, and pain and sedation medications.
5. You may also need lab work drawn prior to the procedure.
6. A mucomyst patch will be applied to your right back. It is cold and has a funny odor. This is to reduce your risk of skin irritation from the radiation.
WHAT HAPPENS DURING THE PROCEDURE?
You will be taken into our procedure room, where you will be positioned on the x-ray table. You will be hooked up to a monitor so your blood pressure, heart rate, and oxygen level can be watched closely. Betadine (a brown colored soap) will be used to wash the area where the tube will be inserted. Lidocaine or Xylocaine (the same medication a dentist uses) will be injected to numb the skin. It will sting and burn for a few seconds before the area becomes numb. The nurse will also be present to administer the pain and sedation (something to help you relax) medications. The radiologist will use x-rays to locate your liver. Next, a needle will be inserted through your skin into a bile duct, contrast dye injected, and the biliary tube will be advanced into the bile duct. You may feel some pressure and discomfort when the tube is inserted.
The biliary tube site will be covered with a dressing. The tube will be connected to a drainage bag. The bile will flow from your common bile duct through the biliary tube into the bag. The fluid may contain some blood at first. However, the blood usually clears over time.
WHAT HAPPENS AFTER THE PROCEDURE?
After the procedure, you will be taken to the recovery room or up to your hospital room on a stretcher. Your vital signs will be monitored frequently for a few hours. You may eat your usual diet, unless you are nauseated or your physician has other tests scheduled. Because everyone is different, the length of stay in the hospital will vary. Before you are discharged from the hospital, an Angio nurse will provide care instructions and supplies with a family member or significant other present.
HOW LONG WILL I NEED THE BILIARY TUBE?
This depends on the reason you needed the catheter.
1. A blockage of the bile duct by stones, infection, scar tissue, or tumor- as long as the blockage is present.
2. A hole in the bile duct- until the hole is healed.
3. In preparation for bile duct surgery- you will need the tube for several days to months after surgery, depending upon what is found at the time of surgery.
Your doctors will discuss with you how long you are likely to need the drainage catheter.
BILIARY TUBE CARE INSTRUCTIONS
HOW DO I CARE FOR THE TUBE?
1. Empty the bag before it is completely full.
2. Sponge baths are recommended in order to keep the dressing dry.
3. You cannot go swimming.
4. You can take a shower if you put a plastic covering, such as Saran Wrap, over the area.
5. The dressing of split sponges, 4x4 gauze and tape, should be changed every 3 days or when it gets soiled, wet, or loose. It is very important to wash your hands before removing the old dressing and then again before applying the new dressing. The Tegaderm (clear plastic) tape which holds the blue plastic ring in place and telfa should only be changed once a week or when it becomes soiled, wet, or loose.
HOW DO I CHANGE THE DRESSING?
1. Assemble supplies: telfa, Tegaderm, scissors, split gauze sponges, 4x4 gauze sponges, tape, connecting tube and drainage bag- if needed.
2. Carefully remove the old dressing, being careful not to pull the drainage catheter and keeping the blue plastic ring against the skin.
3. Inspect the skin around the catheter. Note any unusual redness, tenderness, or drainage. See: Problems you may experience.
4. Wash your hands thoroughly with soap and warm water.
5. Cut a round piece of telfa, the same size as the blue disc, or slightly larger. Cut a slit in the telfa, so that it will fit around the catheter. Place the telfa under the blue disc.
6. Fold a new Tegaderm in half and cut a hole in the center about the size of the nipple on the blue disc. Put the catheter through this hole, and apply the Tegaderm to the skin. If the catheter is attached to a drainage bag, you must first disconnect the bag, then slip the catheter through the Tegaderm.
7. Place two split sponge gauze around the catheter.
8. Fold 4x4 gauze on each side of the catheter, so you are able to curl the catheter once without kinking it. The catheter should rest on the gauze and not the skin.
9. Cover the catheter with 4x4 gauze and secure the dressing with tape.
10. Put a piece of tape below the dressing to hold the catheter and act as a safety device.
11. The external drainage bag should be rinsed out and cleaned once a week with soap and water. Please allow it to dry thoroughly. You are given a second bag to use for these changes.
Supplies may be provided at each appointment. It will be helpful to bring a list of what you need.
You will be scheduled for your tube to be checked every 4 weeks and to be changed every 8 weeks. Please do not eat any solid foods after midnight. If you have a morning appointment, please do not eat breakfast, you may have clear liquids. If you have an afternoon appointment, you may eat a light breakfast, but please do not eat lunch. You may take your medications as usual. However, if you are a diabetic on oral hypoglycemics, do not take your pill if you skip breakfast. For those who are diabetic and take insulin regularly: take half of your NPH dose and only take your normal dose of Regular insulin if you are eating breakfast. We have chemstrips to check your sugar level and juice and lollipops if you feel your sugar is getting low.
If you are unable to keep your appointment or will be late, please call and let us know.
PROBLEMS YOU MAY EXPERIENCE:
1. The blue plastic ring comes away from the skin.
a. If this is only slightly away from the skin, push it back so that it touches the skin. It should move easily without much force.
b. If it is more than 1 inch away from the skin, you need to call the Angio/Interventional Radiology department, explain the problem and make an appointment for the tube to be checked.
2. The catheter becomes kinked.
a. If it is only slightly kinked, straighten it out and redress it.
b. If the kink is severe and/or there is a knot in the catheter, you need to make an appointment with the Angio department for a tube check.
3. The catheter stops draining into the bag. This may occur for 3 reasons:
a. The catheter may be kinked, so change the dressing and check it.
b. The stopcock may be turned off, so check to make sure that it is open. When the knob is in line (parallel) with the catheter, it is open.
c. If you have done the above and it still does not drain, the catheter may be blocked or the catheter may have moved. Please call the Angio/Interventional Radiology department and make an appointment ASAP to get your tube checked.
4. Skin rash.
If the skin under the tape becomes irritated, you may need to change the type of tape you are using. We can provide you with different tape at your next visit.
5. Leakage around the catheter site and/or the blue plastic ring.
Some light yellow drainage around the catheter insertion site is to be expected for the first 1-3 days. If this drainage soaks through the dressing or becomes bloody or contains pus, please call the Angio/Interventional Radiology department for an appointment for a tube check ASAP.
a. Some discomfort is to be expected for the first week after the insertion of a new catheter. Either Tylenol, Aspirin, or Ibuprofen should help decrease the pain.
b. If you suddenly develop pain, please call your primary physician and make an appointment with him/her.
If you get a fever for more than 12 hours, without another cause for the fever, such as a cold or flu, or if your drainage becomes cloudy or bloodier, call the Angio/Interventional Radiology department. If your tube is draining internally, you may be instructed to connect the tube to a drainage bag.
ANY QUESTIONS OR CONCERNS?
PLEASE CALL : DAYTIME- UVa Angio/Interventional Radiology Department (434) 924-9401
AT NIGHT OR ON WEEKENDS - UVa Emergency Room and ask for the Angio/Interventional Radiologist Fellow on call- (434) 924-9400.
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We welcome the opportunity to serve you. Thank you!
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