Taking Care of Your Biliary Drain

Caring for your biliary drainage system can be overwhelming and intimidating. Tiffany McCall, an ARA paramedic and interventional case coordinator, walks you through the steps for caring for your biliary drainage catheter. She covers the equipment, inspecting your dressing, draining your bag, flushing your drain, changing your dressing, and showering with your drain.

Hi, my name is Tiffany. I’m one of the paramedics at Austin Radiological Association. Today, I’m going to talk to you about how to care for your biliary drain.

You’re home from the hospital or the clinic. You’re probably a little bit overwhelmed and intimidated by what’s happening to you right now. Let’s make this as easy as possible.

Your Equipment

Your biliary drain may not be located in the exact same place as it is on this torso. That’s okay. That’s normal. Your equipment may look slightly different. The important thing to know is that where your catheter tubing connects to your drain will always be the same. Your biliary drain may be connected to catheter tubing so that your drain can drain directly into a bag. You may have come home from the hospital with a small cap placed over your biliary drain so that it does not drain freely into the bag.

Let’s talk about a piece of equipment that you may have gone home with that looks a little intimidating. You may have gone home with this piece of equipment between your drain and your catheter tubing. This is called a three-way stopcock. The more you use this and the more comfortable you become with this piece of equipment, the easier this is going to be for you to use.

Doctors typically place this connected to the drain and the other side connects to your catheter tubing. The three-way stopcock may have another piece of equipment attached as well. Some doctors will attach this blue clave device. This device is going to connect where you will flush your tubing. This works the same way this access port works on the three-way stopcock.

Both of these will accommodate a luer lock syringe. When you go home with your new drainage system, you’ll go home with a syringe that will help you clear and flush your device. This syringe is called a luer lock syringe. The luer lock syringe is made so that it screws into the flush port and closes firmly. You will not need to twist this tightly. Just twist until it is firmly in place.

This syringe is a saline syringe that you’ll use for flushing your catheter tubing. The syringe is also a luer lock, so it will screw into your connecting port. Again, you don’t have to screw this in tightly. Just screw until it is attached firmly.

Inspecting Your Dressing

Every day you’re going to inspect your drainage system. Find a handheld mirror or a long mirror, and use that mirror to look at your drain. There should be a little fluid in your drain. It should be free flowing. There should be no kinks and no bends in the tubing between the drain and the bulb or bag. Inspect your dressing. You want to make sure that if your dressing is soiled, wet or appears to be loose, that you change that dressing. When you remove your dressing, take a second and look at the skin underneath. Make sure your skin is intact. It’s normal for it to appear a little abnormal.

You may have to clean that site. Let the site dry completely before you recover and bandage your site. If you have severe pain, or if you notice leakage around the drain insertion site, please contact your doctor immediately. If for some reason your drain has come out, cover your drain with your bandaging materials and go to the local emergency department.

Draining Your Bag

After you’ve recorded your output for the day, you’ll want to empty your bag. Go to the bottom of the bag and twist your blue cap until fluid is draining. You can drain this fluid into a bowl or into your toilet. Once your bag is completely empty, twist your blue cap in the opposite direction, which closes your bag. Remember, before and after emptying your drainage system, make sure and wash your hands thoroughly.

Flushing Your Drain

Let’s talk about flushing your drain. We want to make sure we have a few things ready when it’s time for you to flush your drain. Make sure you have something to clean your access point like an alcohol prep pad. You’ll also need either a prefilled normal saline syringe or a bottle of saline solution, and one of your luer lock syringes.

Before we get started, let’s fill your saline syringe. Remove the top from your saline solution. Break this seal on your luer lock syringe by gently pulling back on the plunger. Insert your syringe into the saline solution and draw back 5 to 10 milliliters of fluid. You’ll notice on mine I have seven milliliters of fluid.

Make yourself comfortable. You can do this from a seated or standing position, or you can lie back. I have this drape for demonstration purposes only. You do not need a towel or a sterile area to flush your drain. When you’re ready, turn your stopcock so that the branch with the word “off” is directly pointing to your catheter tubing. This turns off the flow of fluid from your drain to your catheter and leaves open this port where you’ll insert your flush. It allows for the fluid from your flush to go directly into your drain without going into your catheter tubing. Remove the cap and clean this port. This is where you’ll want to use one of your alcohol prep pads. Open your prep pad, grasp the end, and slowly turn and clean the entire port area.

After you’ve cleaned your port, take your normal saline syringe and firmly insert it into the port. You’ll turn until it is connected. You do not need to over-tighten. This will make it difficult and frustrating to remove. Turn until it is secure. Never pull back on your plunger once connected to your drain.

When you’re ready, slowly push the saline solution into your drain. You may notice a cold feeling. It may feel a little strange. It should not create severe pain.

Once you’ve finished flushing, turn your stopcock so that the “off” limb is pointed towards your flush. This opens up the drainage from your drain into your catheter tubing. Once your stopcock is facing your syringe, you may slowly turn and disconnect your syringe. Once you’ve removed your flush, take your cap, insert it back into your port and tighten it just slightly. Do not over-tighten the cap. This will make it very difficult to remove next time you’re ready to flush your drainage.

If you feel any pain or resistance when flushing your drain, please contact your doctor immediately. Should you experience fever or chills after flushing your drain, call your doctor.

Changing Your Dressing

Let’s talk about changing your dressing. Your dressing will need to be changed every day or every other day. Your dressing should be changed any time it is wet or soiled or loose around the edges. When you come home from the hospital or clinic, you’re going to notice your dressing is probably a little different than what you have to work with. Let’s talk about removing this dressing. Holding your drain cap between your fingers or with one finger on the drain cap, start pulling back on the dressing that is over the blue. Keep in mind this can be very sticky. If you’re having trouble pulling this up, don’t struggle. Use an alcohol prep pad or dampen so that you can pull it back just a little easier. When you pull this back, make sure your finger is holding your drain in place.

You’re going to notice there is a small length of drain outside of your body and on top of this bandage. Pull back this outer layer to expose that small piece of catheter. The blue that this is resting on is also very sticky. You’ll want to keep your hand on your drain and pull back until your drain is free of the dressing. Holding your drain as best you can, go ahead and start removing your outer dressing. This is the dressing that touches your skin. As you start peeling this up, you may notice that you’re leaving behind a little adhesive. That’s okay. That’s normal. As you pull this off, start removing it all the way around the drain, keeping your hand on the drain if possible, so as not to dislodge anything.

You’ll have to forgive us, this torso does not actually have a drain in place. So, you’ll notice, I have white strips of tape holding the drain to the body. When you remove your dressing, you will not have these white strips of tape. Slowly remove your adhesive. Use alcohol prep pads or warm soapy water where you need to to pull this away easily.

Once the drain is free and clear of the dressing, inspect your skin around the drain access point. If you have fluid leaking from the drain, you’ll need to contact your doctor’s office. Inspect this skin to make sure it is intact. You can use saline and gauze to clean the area as needed, keeping in mind the saline and gauze will not remove that adhesive. The adhesive may stay with you for just a little while. When you’re ready, take your supplies.

Today, we’re going to use what you will most likely have at home. We’re going to use four inch by four inch gauze pads and we’re going to use this plastic sheeting called a Tegaderm. Tegaderm outside of the package is just a sheet of plastic that is sticky on all surfaces. With your gauze and your Tegaderm, which we’ll remove from the packaging, use your clean hands. Remember, you’re always going to wash your hands before and after changing your dressing. Take a pair of scissors. You’re going to cut to the center of the 4×4 gauze just on one side. This allows you to place the gauze around the tube as it exits your body. Put the gauze against the drain, allowing the gauze to come together on the other side. You’ll notice that your Tegaderm is just a little bit smaller than this 4×4 gauze. Feel free to bend in the sides of your gauze to cover your drain so that your Tegaderm is able to make contact with the flesh all the way around.

When you peel the Tegaderm from its backing, this entire surface is adhesive. Keeping your gauze together. Lay your Tegaderm across the top of your gauze and slowly pull the Tegaderm until it is taut and touching the skin. You’ll want to press down on your Tegaderm all the way around your bandaging. When you feel like every surface of the Tegaderm is touching your skin, you’ll take one small piece of this white backing and you can remove that. As you go along, just press down firmly on your Tegaderm to make sure it continues to connect with your skin.

Remember to wash your hands when you’re done changing your dressing. Keep in mind, you don’t have to do this alone. If you have a friend or a partner who is able to help you, make sure that both of you clean your hands very well before changing your dressing, and you can instruct your friend or partner what to do to help you best.

This can be a very intimidating process. Changing the dressing is usually what scares patients the most, having to do this alone at home. Become comfortable with your tools. Become comfortable with your drain. Make sure you are telling whoever is helping you exactly what you want them to do so that you can work together to make this as easy as it can be. Every time you do this, it’s going to get a little easier.

Showering with Your Drain

Let’s talk about how to shower safely with your new drain. This is a huge source of anxiety for most patients. You’re told not to get your drain wet. Here’s the important part. Do not submerge your drain under water. No hot tubs. No pools. No bathtubs for soaking.

When you take a shower, you want to cover your drain. You can do this in any number of ways. It doesn’t have to be fancy and it doesn’t have to be perfect. Use what you have on hand. If you have cling wrap, if you have a gallon sized baggie, if you have an H-E-B bag, use what you have on hand to cover your drain to keep it clean and as dry as possible in the shower. For this demonstration, I’m just using household cling wrap. The cling wrap can go all the way around your body. Make sure your drain site is covered well. And, when you have it in position, take a pair of scissors and cut your cling wrap so that it fits to your body. Remember, this is not a perfect science. Water may run down your body and get under the surface of the cling wrap. Do your very best to use your hands to keep that covered. If you have a handheld shower head, using that can help direct the water away from your drain site. If you don’t have a handheld device, try to keep your back to the shower head. As you need to rinse the front of your body, just be aware of where that water is traveling.

Conclusion

I know that we’ve covered a lot of ground today. I know that if you’re not in the medical field, this is incredibly overwhelming and very intimidating. I encourage you to enlist a friend, a family member, someone you trust to help you care for your drain. I encourage you to become very familiar with the drain that’s been placed in your body, the catheter tubing, the bag, the bulb, whatever drainage system you have.

Don’t be afraid to touch your body or the drain. The more comfortable you become with this, the easier this is going to be for you. If you have questions, if you have problems, fall back on your medical staff. Contact your doctor’s office. Contact your nurse. Let them know that you’re struggling. Let them help you through this. We know you can do this.

It’s going to be a little strange at first, but you’re perfectly capable.