It’s another bright day. The sun is up and shining, the birds are chirping, everything seems to be their normal selves. Rita is about to head for work, she puts on her best dress and faces the mirror to do her makeup when…
“What?! Why am I yellow?! Is there something wrong with my eyes? Noooo! I really am a bit yellowish,” she loudly exclaims as she panics. What is wrong with her? She doesn’t understand. Why is her skin turning yellow? All these questions swarm her mind as she heads out the door and goes to the direction of the hospital instead of work. Later on, more questions bombard her as her tests show that her bile ducts are blocked and she is scheduled for a biliary drainage. What is biliary drainage? Should she be worried that she’s about to experience such? How does she prepare for it?
Biliary Drainage: An overview
Biliary drainage is the insertion of a tube into the bile duct and is most commonly carried out when the bile ducts are blocked as it allows bile that has been blocked by a tumor to drain out of your body into a bag or inside your body to your small intestine. In simple words, biliary drainage allows bile to drain from your liver.
Normally, the bile ducts allow bile to drain from the liver to the small intestine. When the bile ducts are blocked, bile cannot leave the body and builds up, thus producing a yellow color in the skin called jaundice and can also cause itching and dark urine. Blockage may be due to several reasons such as gallstones impacted in the ducts, narrowings in the bile ducts after previous surgery and involvement of cancer in the ducts.
The biliary drain is inserted by an Interventional Radiologist and is placed through the patient’s skin and into his/her liver. Other terms for biliary drain are biliary stent and biliary catheter.
A biliary drain may be placed because of leakage or a hole that forms in the bile duct. This leakage can cause severe pain or infection. They may also be placed before surgery or for removal of a bile duct stone.
The patient may be ordered to be on NPO at least 4 hours prior to the procedure since the procedure is carried out under sedation or general anesthetic, and if the stomach is full, stomach contents can involuntarily pass into the lungs.
If the patient is diabetic, he/she may be advised to check with the radiology practice before fasting.
The nurse and doctor may conduct a health history review including the medications that you take. Certain medications such as those that thin the blood may be advised to be stopped to decrease the risk of bleeding. Examples are warfarin, clopidogrel, heparin, enoxaparin sodium, etc.
During the Procedure
Placing the biliary drain will take at least 2 hours and is usually carried out with the assistance of either sedation or a general anesthetic. Intravenous antibiotics are also routinely given before the procedure.
The skin of the abdomen is washed with antiseptic and then a very fine needle is inserted through the skin to administer local anesthetic. A small cut is then made in the skin and a thin needle is passed through the skin into the liver and then into a bile duct inside the liver. X-ray dye or contrast medium is injected into the bile duct, thus allowing it to be seen on X-ray pictures. X-ray pictures or images are taken to see the path of the bile ducts.
After which, a thin wire is passed through the center of the needle so that it lies in the bile duct. A thin drain tube is then inserted over the top of the wire and into the bile duct.One end of the drain tube will remain in the bile duct and the other end sits outside the skin where it is attached to a bag into which the bile drains. It is therefore normal for this bag to fill up with green-brown bile.
After the procedure
After the procedure the patient will be monitored for 4 hours while recovering from the effects of any sedation or anesthetic medications that were used.
For those on out-patient basis, he/she may need someone to drive him/her home as the patient may feel sleepy, tired or dizzy for several hours from the medicine he/she was given.