Bile duct: going home with an external drain

An advice sheet for healthcare professionals and patients

If you are to be discharged with a drain in place, your nurse will teach you how to care for the drain at home. You will learn how to change the dressings around the drain, how to do daily irrigations (flushing the drain with saline) and what to do about showering or bathing.

You should be sent home with the items needed to perform the dressing changes.

Dressing changes

If you are unable to take care of your drain, a district nurse may call to do this or you may be asked to see the practice nurse at your GP surgery.

Instructions for the patient or healthcare worker:

The dressing around the drain will need to be changed once a week, or any time it becomes soiled or wet to prevent infection.

To change the dressing, first gather all the materials you will need and place them close by. To change the dressing, follow the following steps:

1. Wash your hands thoroughly with warm water and soap.
2. Carefully remove the old dressing and dispose.
3. Soak a cotton swab in normal saline solution (sterile salted water provided by the hospital – this is not the same saline used to flush the drain).
   Be careful not to put any pressure on the drain and not to pull on it at any time.
4. Inspect the skin around the drain for redness, tenderness or leakage of pus or bile from around the drain tube. Also check to see that the drain has not changed position and continues to drain. Call your doctor if you notice any of these signs.
5. Slit a 4-inch by 4-inch gauze square from one side to the middle of the gauze and place it around the drain on top of the disc. Slit a second 4-inch-square gauze pad and place it around the drain on top of the first bandage making sure the slits are on opposite edges when the pads are on top of each other.
   Do not place a gauze bandage under the disc; this could cause the drain to pull out.
6. Cover the bandage completely with a clear dressing or strips of sterile tape.
7. Wash your hands thoroughly with warm water and soap.

How to flush the drain

If the drain should suddenly stop draining or become blocked it is possible for it to be flushed. You may flush the drain only if you have been given the appropriate guidance. It is recommended that the drain is flushed with 10ml of saline (ampoules to be provided by the hospital or your GP) and then aspirated.

If fluid will not go into the drain when you try to flush it, you should stop trying to flush and contact your GP or Addenbrooke’s Hospital.

Please contact us immediately if:

• The drain stops draining and does not open up on flushing.
• There is any leakage of bile around the drain
• You have a fever (with or without shivering)
• You have pain in the abdomen, particularly around the drain
• The drain falls out

If you need any further information or clarification, please contact:

Monday – Friday 08:00-16:00
HPB nurses – 01223 256147
HPB administrator – 01223 257103
HPB secretaries –01223 257074

Out of hours
Addenbrooke’s Contact Centre 01223 245151 and ask to speak to
the on-call surgical registrar
or the nurse in charge of ward M4