A biliary drain is a thin, flexible tube placed into the liver or bile duct to allow bile to flow out of the body, preventing a dangerous buildup of fluid when the natural drainage pathway is blocked. This external tube, often called a percutaneous transhepatic biliary drain (PTBD), requires routine maintenance to function correctly. Regular flushing with saline is necessary to maintain the drain’s patency and prevent the thick, viscous bile from causing a blockage inside the catheter.
Understanding the Biliary Drain and Flushing Purpose
The biliary drain catheter is typically a pigtail or similar tube that extends from the skin and connects to a collection bag. Often, the connection point includes a three-way stopcock, which allows flow to be easily diverted to a flushing port. When a stopcock is absent, the procedure requires direct access to a luer-lock port or injection cap located on the tubing itself. This setup is common for drains that connect directly to a collection bag or are capped to allow bile to drain internally.
Flushing the drain is a preventative measure, clearing the catheter of bile sludge, debris, or any buildup that can narrow the tube’s lumen. Bile is a complex fluid containing cholesterol, bilirubin, and fats, which can precipitate and lead to occlusion over time. A blocked drain can cause bile to back up into the liver, potentially leading to a serious infection called cholangitis. Flushing ensures the continual, free flow of bile, which is necessary for the patient’s health.
Essential Preparation and Required Supplies
Preparation must focus on establishing a sterile environment to prevent introducing bacteria into the biliary system. Before gathering supplies, thoroughly wash your hands with soap and water for at least twenty seconds, then dry them with a clean towel. You will need sterile, pre-filled syringes of normal saline, typically 10 milliliters (mL) in volume, as prescribed by a physician.
You will require several sterile alcohol prep pads or antiseptic wipes to clean the access point. For the non-stopcock procedure, you must have a specialized, soft-jawed clamping device or a hemostat to temporarily stop the flow of bile. Sterile gloves should be worn to reduce the risk of contamination while handling the drain. Have a clean, disposable surface, such as a paper towel or sterile drape, set up to place your supplies before beginning the procedure.
Step-by-Step Flushing Procedure Without a Stopcock
The procedure begins by preparing the saline syringe and identifying the drain access point. Remove the cap from the sterile saline syringe and carefully expel any air by holding the syringe upright and pushing the plunger until a small drop of saline appears at the tip. Identify the access port or injection cap on the biliary drain tubing where the flush will be administered.
Before touching the access port, temporarily clamp the drain tubing approximately two inches below the port. This prevents air from being pushed into the bile duct system and stops bile from leaking out when the port is accessed. Use an antiseptic wipe to vigorously scrub the injection port for at least fifteen seconds, allowing it to air-dry completely before proceeding.
Once the port is clean and dry, firmly twist the saline syringe onto the luer-lock connection of the access port until it is securely fastened. Never force the connection or overtighten it. Begin the flush by slowly pushing the plunger to inject the saline into the drain. The recommended technique is the “push-pause” method: inject about one-third of the saline, pause briefly, and repeat this sequence until all the fluid is delivered.
The flush should flow easily, and you should not feel significant resistance or pain. If you encounter any resistance, stop immediately and do not attempt to force the fluid. After injecting the full 5 to 10 mL of saline, untwist and remove the empty syringe from the access port. Immediately remove the clamp from the biliary drain tubing to restore the bile flow to the collection bag.
Recognizing Complications and Safety Protocols
Even with correct technique, complications can arise, and recognizing the warning signs is essential for patient safety. The most immediate sign of a problem is feeling significant pain or encountering resistance during the saline injection. This suggests a complete blockage within the catheter or that the drain has become dislodged; if this occurs, stop flushing immediately and contact a healthcare professional.
Signs of a possible infection, such as cholangitis, include a fever of 100.4 degrees Fahrenheit or higher, chills, or a sudden change in the color or consistency of the bile output. Inspect the skin around the drain insertion site daily for signs of localized infection or irritation, including:
- New redness.
- Tenderness.
- Swelling.
- Leakage of bile or pus.
Accidental dislodgement of the drain requires immediate attention. If the drain falls out, cover the site with sterile gauze, apply gentle pressure, and seek medical attention at the nearest emergency department or call your physician right away. Never attempt to reinsert the drain yourself. Following these protocols and maintaining open communication with your medical team ensures that any issues are addressed promptly.