T-Tube Care

  • Also called a biliary draining tube.
  • May be placed in the common bile duct after cholecystectomy or choledochostomy.
  • The tube facilitates biliary drainage during healing.
  • The surgeon inserts the short end (crossbar) into the common bile duct and draws the long end through an incision in the skin. The tube is then connected to a closed gravity drainage system.
  • Post-operatively it remains in place between 7 to 14 days.

Equipment

  • Graduated collection container
  • Small plastic bag
  • Sterile gloves and clean gloves
  • Clamp
  • Sterile 4”x4” gauze pads
  • Transparent dressings
  • Rubber band
  • Normal saline solution
  • Sterile cleaning solution
  • Two sterile basins
  • Providone-iodine pads
  • Sterile precut drain dressings
  • Hyperallergenic paper tape
  • Skin protectant
  • Montgomery strips

Preparation of equipment

  1. Assemble the equipment at the bedside
  2. Open all sterile equipment. Place one sterile 4”x4” gauze pad in each sterile basin
  3. Using sterile technique, pour 50ml of cleaning solution into one basin and 50 ml of normal saline solution into the other basin.
  4. Tape a small plastic bag on the table to use for refuse

Procedure

  1. Verify the patient’s identity using two patient identifiers, such as the patient’s name and identification number.
  2. Provide privacy and reinforce the explanation of the procedure to the patient
  3. Wash hands

Emptying drainage

  1. Put on glean gloves
  2. Place the graduated collection container under the outlet valve of the drainage bag. Without contaminating the clamp, valve, or outlet valve, empty the bag’s contents completely into the container and reseal the outlet valve.
  3. Carefully measure and record the character, color, and amount of drainage.
  4. Discard gloves

Clamping the T-tube

  1. As ordered, occlude the tube lightly with a clamp or wrap a rubber band around the end. Clamping the tube 1 hour before and after meals diverts the bile back to the duodenum to aid digestion.
  2. Monitor the patient’s response to clamping.
  3. To ensure the comfort and safety, check the bile drainage amounts regularly.

Nursing Interventions

  1. The T-tube usually drains 300 to 500 ml of thin, blood tinged bile in the first 24 hours after surgery.
  2. To prevent excessive bile loss over 500ml in the first 24 hours or backflow contamination. Bile will flow into the bag only when biliary pressure increases.
  3. Provide meticulous skin care and frequent dressing changes since bile is irritating to the skin.
  4. Monitor for bile leakage, which may indicate obstruction.
  5. Monitor tube patency and the condition of the site hourly for the first 8 hours.
  6. Protect the skin edges and avoid excessive taping.
  7. Monitor all urine and stools for color changes.
  8. Reinforce with the patient that loose bowel occur commonly the first few weeks after surgery.
  9. Remind the patient about signs and symptoms of T-tube and biliary obstruction and to report them to physicians.
  10. Teach the patient how to care for the tube at home.
  11. Reinforce with the patient that the bile stains clothing and is irritating to the skin.

Complications

  • Obstructed bile flow, skin excoriation or breakdown, tube dislodgement, drainage reflux, and infection.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

What Do You Think?