Percutaneous Cholecystostomy Tube

Cholecystostomy Tube Instructions

The gallbladder sits next to or under the liver. It is in the right upper abdomen. It is a little sac that stores bile. This helps digest food. When you eat, the gallbladder releases bile through a small duct that goes into the gut. When the gallbladder is blocked (from gallbladder stones or inflammation) and can’t release the bile, the gallbladder may get swollen or infected. This causes what is called “cholecystitis.” You may have some abdominal pain. You may have a cholecystostomy tube placed. This occurs if surgery to remove your gallbladder is unsafe.

Figure 1. Image of a cholecystostomy tube placement.

This is a minimally invasive procedure performed by an Interventional Radiologist. It is performed under x-ray or ultrasound. A thin tube is placed into the gallbladder. This will drain blocked and infected gallbladder fluid. The gallbladder fluid will drain outside your body into a collection bag. This helps your infection get better and will help make surgery safer if it is needed. Once placed, the tube is secured to the skin by either a suture or an adhesive device to prevent accidental removal of the tube. There are many different types of adhesive devices. Which device is used is dependent on which facility placed your drain but all work similarly to hold your tube in place and keep it from becoming dislodged.

Names of several of these devices include: Stay fix, Percufix, Cath grip, Stat lock and, Hollister DTAD. The tube may be left in until you have surgery. Sometimes the tube may be permanently left in. Patients who have gallbladder tubes placed need to have them changed every 6-8 weeks. You will need a follow-up visit for you when the tube needs to be changed. If this has not yet been arranged for you you should contact the facility that placed the cholecystostomy tube to arrange for your routine tube exchange.

Figure 2. Cholecystostomy tube

Figure 3. How the tube should be secured.

The tube will be connected to a drainage bag. It will drain green/yellow/brown bile. The bag should be placed so that it is at waist level or lower. Ensure that the drainage tube and drainage bag are secured well to prevent dislodgement, The extension tubing and drainage bag will be changed when you come to the hospital to have your tube changed every 6-8 weeks as an outpatient.

Figure 2. 600 ml drainage bag.

Cholecystostomy tube care

Flushing

You will need to flush the drain once daily with 10 ml sterile saline or per your doctors’ instructions when you go home.
Clean the flushing port with alcohol and attach the flush syringe.
Turn the stop cock to the open position toward your body.
Gently inject the flush.
Turn the stopcock off to the flushing port and open to the bag.
What if you do not have a stop cock? You can still flush your drain by disconnecting the actual drain from the drainage bag in a twisting motion. Flush the drain and reattach the drainage bag afterwards.

Record output

Empty the drainage bag at least daily or more often if needed.
Input the drainage volume into the MDC tracker.

Site care/ Dressing changes.

Wash hands well with soap and water for 30 seconds.
Remove the current dressing.
Check the tube site to evaluate for any signs of possible infection such as redness, drainage or skin that is warm to the touch.
- Check that the stitches at the skin site are still tight and not loose or that the adhesive securement device is still in place.
- Check for dislodgement of the drain, kinks in the tubing, damage to the tubing, drainage at the site, or debris in the tubing that may be clogging the drain.
Clean the site with saline or soap and water.
Allow the site to dry completely. Do not fan the site to dry it.
Apply a new gauze dressing to the site and secure it with an adhesive film such as Tegaderm or tape.

Cholecystostomy tube care

Decreased or stopped drain output.

Check your drain carefully. Examine the tubing from your skin down the drainage bag. Are there any kinks in the tubing? If so, straighten out the tubing and resecure it in a way to prevent it from kinking.
If your drain has a stopcock attached make sure it is in the open position to drain. If the drainage has not improved you can flush an extra time to see if it is clogged. Flush once toward you with 10 ml sterile saline as described above. If you do not meet resistance but there is still no drainage you can use another 10 ml saline flush and flush downward toward the drainage bag to see if it is clogged in the tubing closer to the drainage bag.

Tube partially dislodged.

Tape the tube in place so it does not come out completely and contact MDC or your local physician. You may need an Xray or a CT scan to see if it has pulled back enough to require replacement.

Tube completely dislodged.

Place a gauze dressing over the site to keep your clothing from becoming soiled. Contact MDC or your local physician.

Redness or drainage at the site.

Examine the site. If the redness is only where the tape was you may have an allergy to the adhesive and may need to switch the adhesive to a different type. Is the site also warm to touch? Is there any drainage from the site? If so, what does the drainage look like? Is there an odor to the drainage? Check your temperature to see if you have a fever > 100.4.
You can contact MDC or your local physician to have it evaluated.

Damage to the equipment such as a torn drainage bag, clogged drainage bag or cracked stop cock.

If these pieces are damaged they will need replacement.
If you were not provided with extra supplies when your drain was placed MDC can help you.

Redness at the site
If you are leaking around the site that requires more than 1-2 dressing changes a day
Drainage around the site that has an odor
A lot of swelling at the entry site
Fever greater than 101 degrees F (38.3 C) (take your temperature if you are not feeling well)
Pain at the tube site or in your side where the tube has been placed that does not go away with pain medicine
The stitch at the entry site breaks
The tube pulls back or falls out
If you can’t flush your drain or if the tube becomes clogged

Percutaneous Cholecystostomy Tube