Tubes and drains

Tube and Drains

Foreward

! “Tubes and drains” is an essential topic in general surgery, yet unfortunately there is no
formal teaching of this topic in our curriculum. We are frequently reminded to “EAT
OURSELVES” and to learn this topic bits and pieces from scattered tutorials. To improve this
ineffective learning situation, I have compiled a document about this topic from some of
materials I have and I hope this can benefit other classmates as well.

! The information in this document was gathered from the “TMH senior handwritten
notes”, “Tubes and drains tutorials by Dr N Mak”, an ebook “Drowning in drainage” and from
my personal notes. I also added some pictures of the tubes and drains and they mostly come
from the internet. Please do not hesitate to verify the information if you are in doubt and do
notify me to make the correction. You are welcome to expand and supplement this document.

! Hope we can enjoy our final year and may we all pass our MB with flying colours.

Jason

2009 Christmas

Edition

! Some revised information and session on tracheostomy, ET tube added based on

anaesthesia and ENT teaching powerpoints and web materials. Again, please verify the
information if you are in doubt.

Jason

2010 Spring

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Tubes and drains

Definition

- A mechanical conduit to allow passage of substance be it gas, fluid and pus from the
body to the external environment

- Not always a tube (e.g. Corrugated drain)

Classification

Active Passive
Open According to Prof Simon Corrugated drain
Ng, this type of drain does Yeaste drain
not exist
Close Chest drain Robinson drain (tube drain)
Jackson Pratt drain

- Passive vs Active
oPassive: Drain by the use of natural difference e.g. gravity, capillary action
oActive (Suction): Drain by the use of suction force e.g. vaccum
 Better tissue apposition

 Effective evacuation

 Less debris blockage

 But may have higher chance of tissue erosion, not used in

abdominal cavity

- Close vs Open
oOpen system: Connected into the environment e.g. Dressing
oClose system: Connected into a container/bag
 Lower infection rate

 Accurate measurement of output

 Reduce contamination and promote infectious control

Purpose

- Therapeutic:
oDrainage of collections of fluid, pus, blood or air
oApposition of tissue to remove a potential space by suction
- Precautionary/ Prophylactic/ Monitor: Prevent leakage, Monitor of output e.g. Foley/
Tubal drain

Size

- Diameter of tubes are often numbered as multiples of 2

- Unit: French (Fr/Ch) : 24 Fr = 24/pi = ~8 mm

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Tubes and drains

Materials

- Common materials (Choice depends on purpose)

oRed rubber e.g. Sengstaken tube, corrugated drain
oLatex rubber e.g. T-tube
 Irritative, stimulate tissue fibrotic reaction

oSilicon rubber e.g. Long term Foley

 Widely use in clinically setting, expensive but inert, harder, suitable
for long-term usage

oPlastic
How to identify a drain during examination?

- By clinical photo
oSpecific features: ʻwaveformʼ of corrugated drain, ʻgrenadeʼ of JP drain
oSpecific colour: NBT – pink, pigtail – white, T-tube – yellow (foley-like)
- By bedside
oSite: nose, neck, chest, abdomen, main-wound
oOutput: NBT & PTBD - bile (golden yellow or deep green), R/D – blood stained
fluid

oMarking on Bedside bag

Complications

- Mechanical
oTrauma at insertion and removal
oErosion of adjacent tissue: fistula, hemorrhage, perforation
oHerniation through tract
oAnastomotic leak: Place too near the anastomoses
- Physiological
oInfection
oLoss of fluid and electrolytes (excessive or inadequate)
oPain
oRestricted mobility
- Malfunctioning
oMigration and dislodgment
oBlockage (Externally by kinking, compression /Internally by tissue, clot
oSuction failure

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Tubes and drains

Common general drains

1.Robinson Drain (Simple drain, tube drain)

a.Features
i. Passive and closed

ii. Made of latex

iii. Not inert, induce inflammatory reaction and fibrous tract formation
iv. Ease for later identification of site of tract
v. Quality/Colour varies from brand to brand

vi. Side-hole, radio-opaque line along the transparent tube, free

drainage to BSB

vii. Frequent change is necessary (1 week max)

b.Indication
i. Anticipated fluid collection in a closed space after major abdominal
surgery, to prevent seroma formation e.g. Pelvic surgery laparotomy
for perforated viscus

2.Jackson-Pratt drain (Vaccum drain)

a.Features

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Tubes and drains

i. Active and close

ii. One-way close system

iii. The bulb must be deflated to provide suction

iv. Flat tube with side holes
v. Similar drain (Minivac)

b.Indications
i. Use as wound drain (Often post-op)

ii. For obliteration of a close space e.g. Parotid, MRM, thyroid surgery

3.Redivac® drain

! ! !

a.Features
i. Active and close

ii. Ready-to-use vaccum drain

iii. Vacuum established in OT

iv. The angle of the antenna indicates vacuum status
1. V shape: good vacuum > Increase angle as vacuum loses
v. Same principle as JP drain, connected to glass bottles

b.Indication: Same as JP

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Tubes and drains

i. Commonly seen in orthopedics

c.Placement and Removal

i. Remove if < 30 milliliters of fluid are draining from it in a day

ii. Removal (3S)

1. Stitch removal
2. Suction discontinuation
3. Slow and steady pull
4.Pigtail catheter

a.Features
i. Pigtail curve with side holes to avoid tissue trauma and improve
draining surface area

ii. Can be locked after placement to prevent dislodgement

b.Indication
i. For deep seated collection

ii. For percutaneous nephrostomy, renal pelvis drainage

c.Placement and Removal

i. Placed under imaging guidance

Urinary Catheter

5.Urinary Foley catheter

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Tubes and drains

a.Features:
i. Balloon

1. For injection of water (which have the same density of urine)

2. Self-retaining (Keep the catheter inside the bladder) to
prevent self-off when the patient urinates

3. SALINE SHOULD NOT BE USED TO INFLATE THE

BALLOON AS IT MAY CRYSTALIZE AND BLOCK THE
TUBE (ASK FOR “WATER FOR INJECTION”!)

4. In case balloon fails to deflate, keep pumping in water to burst

it in side the bladder

ii. Valve

1. Made of self-sealing rubber to prevent leakage from puncture

hole, gateway for inflation of balloon (Dome valve)

b.Types
i. Latex Foley: Short term drainage, yellow

ii. Silicon-treated Foley: Minimize inflammatory reaction for long term

placement, transparent

iii. 3-way Foley: To be used in hematuria patient, water can be used to

flush when necessary

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Tubes and drains

iv. Hematuric catheter: Metal core, harder than normal

c.Indications
i. Drainage of urine
ii. Foley catheter can be used to drain suprapubic bladder
iii. Chest drain in emergency
iv. Stop nose bleeding by inserting into nasopharynx
v. Stop anorectal bleeding
d. Contraindication
i. Urethral trauma
e. Complications
i. UTI
ii. Trauma to urethral tissue
f.Placement and Removal
i. Suprapubic

1. Open method: OT
2. Close method: US guided at bedside
ii. Procedure of insertion of Foley

1. Patient identification, assess indication and contraindication

2. Consent
3. Position (Leg spread and feet together)
4. Aseptic procedure and universal precautions
5. Gather equipment (urinary catheterization set, CHECK
EXPIRY DATE)

6. Open urinary catheterization set under aseptic technique

7. Ask assistance to pour you antiseptics solution and draw a
syringe of water for injection

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Tubes and drains

8. Soak cotton wool with antiseptics and prepare lubricant

9. Check balloon of the catheter and coat the catheter with
lubricant

10.Drape the sites with sterile cloths

11.Prepare the catheter and the kidney bean container for urine
collection later (put it on the draped area)

a.16-20 (Adult)
b.28 (Post-op prostate surgery)
c.8 (Children)
12.Using dominant hand to handle forceps, cleanse peri-urethral
mucosa with cleansing solution. Clamp the forceps on outer
wrapping of the set

a. Cleanse anterior to posterior, inner to outer, one

swipe per swab, discard swab away from sterile
field.LA catheter gel for analgesia

b. Pick up the penis and retract the prepuce with the

non-dominant hand (NOW CONTAMINATED) and
cleanse the urethral meatus

13. Pick up the catheter by the dominant hand and insert beyond
1-2 inches where urine is noted (collect the urine with the
kidney bean container)

a. Male: Make sure urine flow out before pumping

balloon (Prevent the risk of damaging the
membranous urethra)

14.Inflate the balloon and gently pull the catheter until it is snug
against the bladder neck

15.Connect to bedside bag

16.Reduce the prepuce and correct taping of the foley
17.Documentation and proper disposal of waste
6.Malecot catheter

! ! ! !

a.Features

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Tubes and drains

i. Self-retaining

ii. Rubbery and elastic

b.Indications
i. Chest drain

ii. Jejunostomy feeding (No balloon has to be inflated to keep it in-situ

thus no risk of luminal obstruction

Abscess drainage

7.Corrugated drain

a.Features
i. Passive and open

ii. A waveform strip of rubber and fit loosely and push into the depth of
wound

b.Indications
i. Commonly used in limb wounds to drain DEEP SEATED ABSCESS

ii. Skin recovery > Subcutaneous tissue recovery, so delaying wound

closure

8.Yeates tissue drain

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Tubes and drains

a) Corrugated; b) Penrose; c) Yeates

a.Features
i. Passive and open drain

ii. Row of strawsʼ - Increase surface area and lumen provides capillary
action drainage

iii. Suitable for large volume drain

b.Indications
i. Same use as corrugated drain

Nasogastric drainage

9.Ryleʼs tube

a.Features
i. Commonly used nasogastric tube

b.Indications:
i. To drain gastric content to decompress stomach and prevent
aspiration e.g IO or intraop use

ii. Feeding (Not for long-term uses due to microaspiration pneumonia

and discomfort

c.Placement and Removal

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Tubes and drains

i. Estimate length: Nose > around ear > 5cm below xiphoid

ii. Place NGT straight back (not up or down) through the nose

iii. Keep asking the patient to swallow and neck flexed

iv. Confirm by 1: Auscultate for gurgling sound over stomach while
injecting air; 2: Aspirating gastric content and test with Litmus paper
pH <2 ; 3: Chest XR to confirm correct placement

10.Entriflex® tube!

a.Features
i. Metalic weight at the end of tube (to ease placemet)

ii. Radio-opaque: (to ease positioning by X-ray)

iii. Central guidewire to facilitate insertion

b.Indications
i. Nasogastric tube for prolonged usage (thinner, siliconized to
minimize tissue reaction and discomfort)

ii. NOT for aspiration

c.Placement
i. Must pass the pylorus to facilitate absorption

11.Infant feeding tube (Fine bore feeding tube)

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Tubes and drains

a.Indications
i. Infant feeding

ii. Temporary splinting of fibrous tract in PTBD dislodgment

iii. Probing in exploration of fistula

iv. Central line/Hickmannʼs catheter
v. Renal transplant patient

1. Inserted in ureteric orifice to prevent obstruction by fibrosis

12.Sump drain

! ! !

a.Features
i. Active and OPEN system

ii. (Prof Simon Ng: Active and Close)

iii. Double lumen (large outflow lumen and smaller inflow lumen)
iv. Sieve system
1. To prevent solid content to block the suction by continuous
release of pressure

b.Indications
i. Pancreatic surgery

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Tubes and drains

ii. As a nasogastric tube

13.Sengstaken-Blakmore tube

a.Features
i. 4 channels (+ eso aspiration port = Minnesota tube)

1. Esophageal balloon
2. Esophageal aspiration (for saliva and monitor leakage, may
be absent)

3. Cardiac aspiration (Monitor bleeding)

4. Cardiac (Gastric) balloon
ii. 2 balloons

1. Cardiac balloon
a.As a tamponade to stop bleeding
b.Inflated by 200-300 cc contrast + water to ease
assessment of tube position by X-ray

c.Water + methylene blue to visualize leakage if the

balloon burst

2. Esophageal balloon
a.Inflate with gas, 40 mmHg (>capillary perfusion
pressure)

b.Markers in cm for measurement

iii. Stored in fridge to harden the tube for easier insertion
b.Indications
i. Temporary hemostasis of variceal hemorrhage by direct
compression at bleeding site (<24hr)

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Tubes and drains

ii. Aim:

1. Prevent exanguination (Massive bleeding that prevents

immediate endoscopy and sclerotherapy

2. Stabilize patient before more definite treatment e.g.

endoscopic sclerotherapy and banding

! ! !

c.Contraindication
i. Large hiatal hernia

ii. Known esophageal stricture

iii. Unconfirmed variceal bleeding (? PUD)

d.Drawbacks
i. Hazardous and uncomfortable: GA and tracheal intubation in
confused or agitated patients may be need

ii. Skillful surgeons needed

iii. Achieve temporary control, prolonged pressure will lead to necrosis

of tissue

14. Rectal tubes

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Tubes and drains

a. ~ NGT but shorter

b. Short term use only

c. Indications

i. Decompression of the LB (Commonly after derotation of volvulus)

ii. Drainage of liquid feces and flatus

Cardiopulmonary drainage

15.Nelaton catheter

! ! !

a.Suction catheter (Sputum suction)

b.Indications
i. Commonly used in emergency trolley/anesthesia to keep the airway
patent.

1. Cholinergic drug will increase parasympathetic activity and

highly increase mucus secretion

ii. Rectal irrigation/washout (Thick and big catheter used)

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Tubes and drains

16.Chest drain

a.Features
i. One bottle

1. When the drain works, air is drawn out

2. Check for a) air bubble b) water column level swinging
ii. Two bottles

1. Apply suction, same mechanism as Sump drain, open,

release the pressure

2. ʻTo draw out the bubblesʼ

iii. Three bottles

1. A collecting chamber is applied

2. Similar to 2-bottle system, additional markings on first bottle
as the collection bottle

a.Collection chamber: To collect pleural fluid

b.Underwater seal: To prevent air from being sucked in
by negative pleural pressure during inspiration

i. Swinging should be looked for as a rise an
d fall of the fluid level in the tube

ii. Bubbling should be looked for in the under
water seal chamber; as indicated earlier 

c.Suction regulator: The amount of vacuum is directly

proportionate to depth of the tip of the central tube
under water surface (e.g. suction of -20cm H2O is

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Tubes and drains

achieved by placing tip of tube 20 cm below surface)

i. It should always be bubbling

Underwater seal chamber Interpretation

Swinging Bubbling
Yes Yes Indicates air leak (can be from the lung or somewhere along
the circuit).
The degree of bubbling reflects the amount of air leak.
The swinging reflects the negative pressure within the pleural
space.
Swinging is only seen if suction is not applied to the chest
drain unit, and decreases as the lung re-expands.
No No Indicates resolution of air leak and effusion, with lung re-
expansion.
Make sure the tube is not obstructed.
No Yes Indicates a possible connection or system air leak.
Can temporarily occlude the chest tube right at the skin exit
and if the bubbling continues then the leak is external to the
patient.
A hissing sound may point to the leak.
Tape all connections securely.
Yes No May be seen with partial or total pneumonectomy and in stiff
lungs

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Tubes and drains

! !

b.Indications
i. Pneumothorax (>20%)

ii. Trauma patient (hemothorax)

iii. Effusion, empyema

c.Placement and Replacement
i. Note

1. Position of drain
a.Apex of pleural cavity: Pneumothorax
b.Base of pleural cavity: Effusion/Emphysema
c.Confirmed by X-ray
2. Size:
a.24 Fr (for effusion and air)
b.28 Fr (for blood and pus)

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Tubes and drains

3. Suction pressure: 15 mmHg (~ negative pleural pressure)

ii. Caution

1. NEVER clamp a drain except in changing bottle as it can

result in tension pneumothorax

2. NEVER push the chest drain back into the pleural space as it
is now contaminated, change a new drain

iii. Insertion
1. Patient identification, assess indication and contraindication
2. Aseptic procedure and universal precautions
3. Administer local anesthetics, infiltrate all layers until needle
can aspirate free gas or fluid (inside pleural cavity)

4. Incision on the 4th ICS between anterior and mid-axillary line

5. Perform a blunt dissection OVER the rib into the pleural space
6. Finger exploration to confirm intrapleural placement
7. Direct drains basally for effusion and apically for
pneumothorax

8. Skin suture over the wound and make a knot, form a 2 cm

sling by tying another square knot 2cm from previous knot.
Tie the sling to the drain, make several knots to prevent
slipping

9. Confirm position with CXR

10.Beware of re-expansion pulmonary edema
11.Daily CXR until removal
iv. Complications
1. Trauma (Pneumothorax, hemothorax, hemoptysis, air emboli,
liver and spleen)

2. Re-expansion edema
3. Empyema
4. Vagal shock
5. Seeding mesothelioma
6. Surgical emphysema
17.Trachectomy tube
a. Features
i. Surgical procedure
ii. Definitive airway

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Tubes and drains

! !

iii. Outer tube (above), inner tube (middle), obturator (below), balloon
iv. Type: Nonmetal/metal, cuffed/uncuffed, fenestrated/unfenestrated,
short/long term, single/double lumen

v. Size: the largest and the most tolerable one ~3/4 diameter of trachea

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Tubes and drains

Tube Indication Recommendations

CuffedTube with Disposable Inner Cannula

Used to obtain a Cuff should be inflated when using with

closed circuit for ventilators.
ventilation
Cuff should be inflated just enough to
allow minimal airleak.

Cuff should be deflated if patient uses

a speaking valve.

Cuff pressure should be checked twice

a day.

Inner cannula is disposable.

Cuffed Tube with Reusable Inner Cannula

Used to obtain a Inner cannula is not disposable. You

closed circuit for can reuse it after cleaning it thoroughly.
ventilation

Cuffless Tube with Disposable Inner Cannula

Used for patients with Save the decannulation plug if the

tracheal problems patient is close to getting
decannulated.
Used for patients who
are ready for Patient may be able to eat and may be
decannulation able to talk without a speaking valve.

Inner cannula is disposable

Cuffless Tube with Reusable Inner Cannula

Used for patients with Inner cannula is not disposable. You

tracheal problems can reuse it after cleaning it thoroughly.

Used for patients who

are ready for
decannulation

Fenestrated Cuffed Tracheostomy Tube

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Tubes and drains

Used for patients who There is a high risk for granuloma

are on the ventilator formation at the site of the fenestration
but are not able to (hole).
tolerate a speaking
There is a higher risk for aspirating
valve to speak
secretions.

It may be difficult to ventilate the

patient adequately.

Fenestrated Cuffless Tracheostomy Tube

Used for patients who There is a high risk for granuloma

have difficulty using a formation at the site of the fenestration
speaking valve (hole).

Metal Tracheostomy Tube

Not used as frequently Patients cannot get a MRI.

anymore. Many of the
One needs to notify the security
patients who received
personnel at the airport prior to metal
a tracheostomy years
detection screening.
ago still choose to
continue using the
metal tracheostomy
tubes.

b. Indications
i. Failed intubation
ii. Therapeutic
1. Chronic airway obstruction (OSA, H&N Ca obstructing AW)
2. Acute airway obstruction: “When you think of it” Mosemʼs
dictim

iii. Prophylactic
1. H&N surgery postoperative swelling
c. Care
i. Suck and humidify
ii. Hygiene: clean the inner tube and chest physio

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Tubes and drains

d. Complications
i. Immediate
1. Trauma to the airway and neighbour anatomical structures
a. Brachicephalic vein: particularly in children
b. Esophagus
c. RLN
d. Trachea
e. Pleura: pneumothorax
2. Delayed
a. Irritation and Infection
b. Malpositioning, displacement, erosion
c. Obstruction
i. Acute emergency, CALL FOR HELP
ii. Replace with non-fenestrated inner tube (if
present)

iii. Try venitlating through the replaced tube

iv. Try pass suction catheter to look for
obstruction

v. Deflate the cuff and bag-mask around the

tracheosteomy space

vi. Remove the tracheostomy, cover with

dressing and ventilate through mouth if still
cannot ventilate

vii. Avoid re-inserting if recently created (tract

not mature, may insert into the
mediastinum

viii. Avoid removal of tube if recently created, try

to unblock it with suction catheter

d. Subcutaneous emphysema
e. Aspiration
f. Persistent fistula (skin-trachea/ trachea-esophagus)
g. Stenosis of AW
h. Tracheomalacia
i. Difficulty in weaning off
j. Scar (keloid)

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Tubes and drains

k. Unable to speak
18.Laryngeal mask airway

a. Features
i. NOT a protected airway, aspiration can still happen
ii. Inflatable cuff to seal off the laryngx
iii. Can be sterilized and reused
iv. Newly introduced in late 1980s
v. Can be inserted blindly without laryngoscope
19.Endotracheal tube

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Tubes and drains

a. Features
i. ET-tube
ii. Plastic, disposable
iii. ET cuff
iv. Size marked on the tubes, length marking for insertion depth
1. The double black line marks the position level for vocal cord
2. 7 for female and 8 for male (usual)
v. Can be double lumen for selected one lung ventilation
1. One lumen open in the trachea, one in the main bronchus,
usually the right main bronchus (more vertical, easier
insertion)

b. Indication
i. Airway protection (massive hemoptysis, hematemesis, GCS <8)
ii. Ventilation (during resuscitation, operation)
c. Contraindication
i. Cervical spine injury: fiberoptic intubation
ii. Mass lesion obscuring the upper AW
d. Placement
i. Insertion: With help of laryngoscope, stylet or bougie to guide the
insertion

ii. Sedation: With rapid sequence induction to prevent gag reflex and
aspiration

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Tubes and drains

iii. Ventilation: With SaO2 and bag mask for oxygenation, end-tidal CO2
and monitoring

iv. Prepare equipment (laryngoscope, ET tube, syringe for air

insufflation, lubricants, bourgie/stylet, stethoscope for auscultation,
bag and mask for preoxygenation and ventilation

v. Check equipment (laryngoscope, balloon of the ET tube: inflate with

10 ml and deflate)

vi. Prepare the patient with reoxygenate the patients with 100% O2 for 5
mins

vii. Prepare the airway with head-tilt chin lift maneuver

viii. Rapid sequence induction: (Pressure, Sedate, Paralysis)
1. Apply cricoid pressure
2. Short acting sedatives (midazolam and propofol)
3. Rapid acting paralytic agents (suxamethonium, ~3 min with
visible muscle twitching)

ix. Insertion (should be <15 sec, otherwise re-oxygenate before retrial)

1. Largngoscope (hold with left and tilt the tongue to the left,
avoid hinging on teeth, blad to valleculae, push the tongue
down and pull the jaw to the ceiling)

2. Slide the ET tube down after visualization ofthe vocal cord

(usually to 22 cm mark)

3. Inflate the cuff (10ml and feel the pilot balloon)

x. Position confirmation
1. By bagging: smooth bagging
2. By P/E: symmetrical and adequate chest expansion and
good AE on auscultation (3 pt: L/R chest and epigastriu)

3. By Ix: Postive ETCO2 (gold standard), CXR confirmation: 2

cm above the carina

e. Complications
i. Damage to oropharyngeal airway: teeth, trauma, hoarseness
ii. Esophageal intubation (inflated stomach with unprotected airway >
aspiration)

iii. Ventilation associated infection in long term use

iv. Sedation complications (malignant hyperthermia in suxamethonium)
Hepatobiliary drainage

20.Nasobiliary tube
a.Features

27
Tubes and drains

i. Pink in colour with side holes

b.Indication
i. Temporary relief of biliary obstruction similar to internal stent

1. Efficacy similar to internal stent

2. Enable drainage monitoring in very ill patients
c.Relative C/I
i. Confused patient (They will pull off the drain)

d.Placement and Removal

i. Placed via ERCP up to right hepatic duct

ii. Removed within same admission

iii. AXR showed alpha sign confirms good position

21.Percutaneous transhepatic biliary drainage

a.Features
i. Invasive

ii. Inserting a catheter through a skin incision into the obstructed bile
duct > CBD > Ampulla of Vater > Duodenum

iii. Cholangiogram is performed in the same setting to define the

anatomy

iv. Subsequent internalization (either internal/external drainage or

internal drainage by stenting on another day, usually days or weeks
after the initial PTBD) of the PTBD facilitates internal drainage of
bile, which reduces the loss of fluid and electrolytes

v. Side-holes along the drain extending back to about 15 cm from the

tip (instead of 5 cm with multi-purpose catheters).

vi. Extra proximal holes allow the catheter to serve as a stent. Bile from
the upper part of biliary tree will enter the proximal side-holes and
run within the biliary catheter before exiting into the duodenum via
the distal side-holes.  

b.Indication
i. Biliary decompression and ERCP contraindicated

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Tubes and drains

c.Placement and Removal

i. Placed under image guidance with DILATED DUCTS by a
radiologist with special training in the Department of Radiology

ii. Patient needs to hold breath at inspiration.

d.Complications
i. Cholangitis and wound infection

ii. Catheter dislodgement

iii. Hemobilia and sepsis

iv. Injury to other organs (Kidney, perforation of duodenal diverticulum,
pleura > Pneumothorax and bilothorax

v. Contrast related

22.Cholecystostomy tube
a.Features
i. To drain the gallbladder

b.Indication
i. Mx of acute cholecystitis in surgically unfit patients

c.Placement and removal

i. Placed in OT surgically or percutaneously

23.T-tube

! !

a.Features
i. Siliconized/ non-siliconized/ latex

ii. Normally used size: 14,16,18

iii. T-tube is placed inside the common bile duct

iv. Distal portion of the duct blocked: bile will be drained out
v. Intraluminal black removed: bile will flow down CBD

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Tubes and drains

b.Indication
i. Safety valve for bile drainage in case of temporary obstruction after
exploration of CBD

ii. Small drain (with the head of T-tube cut, Max 18 Fr)

c.Placement and Removal

i. Placed in the OT

ii. Upper limb should not be longer than the level of hila

iii. Lower limb should not touch the ampulla of Vater

1. ʻCut-openʻ: To prevent crystallization of bile and blocking the
tube

2. ʻTiltedʼ: To prevent obstruction to flow (CBD is not straight)

iv. Removal
1. Day 10: Retrograde/T-tube cholangiogram to reveal CBD/
choledocoscope

2. Day 14: T-tube withdrawal with a fibre-tract well formed.

Spontaneous closure of the hole will be achieved <1 hr after
removal

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