Percutaneous Biliary Drainage

What is percutaneous biliary drainage?

Percutaneous biliary drainage is a procedure that drains bile from the liver. A tube is placed through the skin into the liver to relieve jaundice (yellowing of the skin) caused by a blockage in the bile duct.

Why do I need percutaneous biliary drainage?

Usually, the goal is to relieve jaundice caused by a blockage of the bile ducts that drain bile from the liver into the intestine. Gallstones, tumors or scarring may cause a narrowing or stricture, blocking the flow of bile from the liver into the intestine. Bile collecting in the liver can be harmful, but percutaneous biliary drainage provides relief by diverting the obstructed bile to the outside of the body.

How is percutaneous biliary drainage performed?

Prior to your procedure you will be asked to undergo the following tests or procedures to evaluate your condition:

History and Physical Examination
Blood tests
Imaging (CT, MRI, MRA)

The procedure is performed in the interventional radiology suite. First, the nurse will give you a sedative through the intravenous line, which will be placed in your arm. You will feel relaxed and sleepy, but you will be awake throughout the procedure. The Interventional Radiologist will numb an area of your abdomen with a local anesthetic. After you are given a local anesthetic, the Interventional Radiologist will insert a small needle into your liver. Through this needle, contrast (x-ray dye) will be injected to see your bile ducts and the catheter, or drainage tube, will be placed into the bile ducts. The catheter will remain in place to drain bile into a drainage bag. The catheter is secured to your abdomen to hold it in place. A dressing is then applied to the catheter entry site.

What will happen after the percutaneous biliary drainage?

After the procedure, you will return to your hospital room. Your nurse will check the catheter. The bile will drain outside your body into a drainage bag for several days. If the blockage in the liver is very tight, the Interventional Radiologist may have initially placed the drainage catheter above the blockage site. If this is the case, then you will return to the interventional radiology suite after 2 or 3 days and the Interventional Radiologist will pass the catheter through the blockage and into the small bowel. Once the end of the catheter is in the bowel the drainage bag can replaced by a cap and the bile will drain internally from the bile ducts into the bowel.

You should keep the skin around your biliary catheter clean and dry. You can take a shower, but you should tape plastic wrap or a plastic bag around the bandage. Clean the tube site daily with hydrogen peroxide and allow the skin to dry. Apply a sterile gauze dressing and attach with paper tape. The catheter should be flushed once a day in order to clean any debris out of the holes in the catheter. Flush with 10 ml of saline. Push the saline in towards the catheter (not the drainage bag). Flush slowly in only. Do not pull back fluid into the syringe. By pulling the solution back into the syringe, you may pull the debris back into the catheter.

Problems you should be aware of:

1. If the skin around the catheter becomes red and sore, you may have a skin infection. Apply some antibiotic ointment to the skin when you change the bandage. If it does not clear in two days, call your primary care doctor.
2. If you develop a fever greater than 100° fahrenheit, chills or vomiting, you should call your primary care doctor immediately.
3. If your catheter begins to leak around the skin site onto the bandage, it needs to be changed. If this occurs at night, call the office the following morning for an appointment at (305) 932-7800. If your catheter has been capped and you have a drainage bag in storage, connect the catheter to external drainage.
4. If your catheter falls out, call the office immediately at (305) 932-7800. Usually, a catheter that has fallen out can be easily replaced with a new catheter if performed within 24 hours.