What is bile?
Bile (also called biliary fluid) is a yellow, greenish, brown fluid that is made by the liver and stored in the gallbladder. Bile is made up of cholesterol, bile acids, bilirubin (a breakdown product of red blood cells), water, salt from the body (potassium and sodium), and metals. Bile helps in digesting the foods you eat by breaking down fats into fatty acids. The digestive tract absorbs these fatty acids.
Bile moves to different organs through tubes called bile ducts. The common bile duct connects the liver, gallbladder, and pancreas to the small intestine. When you eat, bile moves from the gallbladder to the duodenum (first part of the small intestine). This is where bile helps with digestion.
What is a biliary blockage?
Sometimes bile does not flow as it should. This backup of bile fluid is called cholestasis. Blockage in the bile duct can be caused by a number of health issues including:
- A tumor pressing against the bile ducts.
- Hepatitis (when the liver is inflamed).
- Cirrhosis (scarring of the liver).
What are the signs of cholestasis?
The backup of bile can lead to:
- Jaundice (yellowing of the skin, eyes, and nails).
- Darker urine than normal.
- Pale colored stools.
What is a biliary drain?
In some cases, a biliary drain is placed to help remove extra bile. A biliary drain is a thin tube that is flexible and hollow. This drain collects extra bile from the bile ducts. When a drain is placed, it is attached to a collection bag outside the body.
In some cases, a stent is placed instead of a drain. If a stent is used, it is placed in the bile duct to keep the duct open and help the flow of bile from the liver into the intestine. Whether you have a stent or a drain placed will depend on your situation.
How is a biliary drain placed?
Biliary drains are often placed as an outpatient procedure. You may be given medications so that you can relax and so you don't remember the procedure. You will be monitored for a few hours after the procedure before you are allowed to go home. You should have someone drive you home.
How a biliary drain is placed will depend on your situation, but in general:
- Your belly will be cleaned and a local anesthetic (numbing medication) will be given with a small needle to numb your skin.
- A different needle is inserted into the skin and into a bile duct in the liver.
- Dye is injected so the bile ducts and liver can be seen on an x-ray.
- The biliary drain is placed into the bile duct so that it can drain. The drain is attached to a bag.
What are the risks associated with having a biliary drain placed?
The risks of biliary drain placement are similar to those of any procedure. Bleeding and infection are risks. There is also a risk of the gallbladder or intestine being punctured.
How can I care for myself after the drain is placed?
Make sure to get plenty of rest and eat a healthy diet. You will want to drink plenty of fluids to not only stay hydrated but to also make up for what is lost through your biliary drain. Do not sleep on the same side as your drain, as this can lead to the tube not being able to drain. You can go back to normal activity 24 hours after the tube is placed, but you want to avoid lifting anything heavier than 10 pounds. Follow your provider's instructions for showering.
How do I care for my biliary drain?
You may have a dressing at the placement site. To change the bandage, first wash your hands with soap and water. Take the bandage off. Clean the site with soap and water. When your skin is dry, place a new bandage, using tape to secure it. Be careful to not pinch the drainage tube with the tape.
You should not have to do much to care for the tube. To keep it clear, you may need to flush it with sterile saline. Your provider will tell you how often you need to do this and a provider will teach you how to do it.
The bag connected to your drain should be emptied when it is about 2/3 full. To empty the bag:
- Wash your hands with soap and water.
- Open the drainage port at the bottom of the bag.
- Empty the contents either into the toilet or into a measuring cup if your provider wants you to keep track of how much is being emptied.
- Clean the drainage port with soap and water and close it.
- Wash your hands with soap and water.
When should I call my provider?
Call your provider if you have:
- Fever or chills, which can be a sign of infection. Your provider will tell you at what temperature they should be called.
- Redness, drainage, or a foul smell coming from the drain site.
- Belly pain.
- Dark-colored urine.
- No bile in your drainage bag. If this happens, make sure the tube is not pinched anywhere and that the bag is below where the drain was placed. You may need to take your dressing off to check. If it is pinched, straighten it out. The tube may also need to be flushed. If these techniques don't work you should call your provider.
If you have any questions about your biliary drain you should contact your provider.
American Cancer Society. Palliative Therapy for Bile Duct Cancer. 2018.
British Society of Interventional Radiology. Biliary Drainage and Stenting.
National Cancer Institute. Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®) – Patient Version