B-09: Biliary Catheter Exchange

• Indications
  • Routine maintenance for chronic biliary catheter drainage
  • Ancillary to biliary interventional procedures
• Contraindications
  • None
  • Caution in patients with severe coagulopathy
• Patient Evaluation
  • Ability to lie still, hold breath, and cooperate during procedure
  • Consider anesthesia (MAC or general), especially if additional interventions are planned
• Preprocedure Orders
  • Routine
  • Antibiotics: IV start night before procedure, PO start 3 days prior to procedure
• Tools
  • Bentson and Coons or Amplatz wires
  • Cope biliary drainage catheter w/ metal stiffener
  • Molnar disk, ligature (#2 silk), Tegaderm
• Entry site
  • Established
• Technique
  • Perform cholangiogram through existing catheter(s). Divide catheter(s) and remove over Coons or Amplatz wire(s). Additional cholangiography can be done over wire using 6Fr. vascular sheath. Cut any additional sideholes needed based on the catheter removed. Mark most proximal sidehole with Bentson. Insert new catheter, form and position using Bentson as a guide. Secure catheter and cap or place to bag drainage as necessary.
• Post-procedure Note
  • Note type and size of catheter(s) placed and if external only or internal/external drainage
  • Note ancillary procedures done (i.e., brush biopsy, balloon dilatation, stone manipulation)
  • Note scheduled follow-up appointment
• Post-procedure Order
  • Inpatient
    1. Catheter to [gravity][internal] drainage. Record output q shift if gravity drainage
    2. Check and record VS:
       • q 15 min x 2, then
       • q 30 min x 4, then
       • q 60 min x 4, then
       • q 4 hours if stable
    3. Call H/O for any change in VS
    4. Antibiotic coverage (PO or IV) per H/O to continue for 72 hours minimum
    5. Resume other preprocedure orders
  • Outpatient
    1. Continue antibiotics for 3 days following procedure
    2. Return to Interventional Radiology on ___________ for reevaluation
    3. Begin PO antibiotics 3 days prior to next scheduled appointment
    4. Dressing changes as instructed PRN
    5. Seek care from local physician or emergency department, or call Department of Radiology for dislodged tube, leakage around tube, pain, swelling or tenderness at site, fever, or chills

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