Do you need to flush a Percutaneous Transhepatic Cholangiography (PTC) drain?

PTC Drain Flushing: Indications and Technique

Yes, PTC drains should be flushed regularly to maintain patency and prevent complications. 1 Regular flushing of percutaneous transhepatic cholangiography (PTC) drains is essential to prevent drain occlusion, which can lead to biliary obstruction, cholangitis, and sepsis.

Rationale for PTC Drain Flushing

PTC drains are prone to occlusion from:

• Bile sludge accumulation
• Blood clots
• Debris
• Biofilm formation

Without regular flushing, these materials can obstruct the drain, leading to:

• Drain dysfunction
• Biliary obstruction
• Ascending cholangitis
• Sepsis
• Need for premature drain exchange

Flushing Protocol

Frequency:

• Regular flushing should be performed at least once daily
• More frequent flushing may be required if there are signs of sluggish drainage or thickened bile

Technique:

1. Use sterile technique
2. Use sterile normal saline (typically 5-10 mL)
3. Flush gently to avoid excessive pressure in the biliary system
4. Aspirate before flushing to check for drain patency
5. Document the color and amount of drainage

Clinical Considerations

Transhepatic Approach Benefits:

The transhepatic approach for PTC drains is preferred because it 1:

• Reduces risk of bile leak
• Allows the drain to be left in place for longer periods
• Leads to quicker maturation of a drainage tract
• Decreases risk of portal vessel injury and hollow viscus injuries

Drain Management:

• PTC drains should typically remain in place for 4-6 weeks to allow tract maturation 1
• A cholangiogram via the drain is recommended 2-3 weeks after placement to ensure biliary tree patency before removal 1
• In patients with diabetes, ascites, long-term steroid therapy, or malnutrition, the drain should remain in place longer as these conditions may hinder tract maturation

Complications to Monitor:

Regular flushing helps prevent complications, which occur in up to 61.9% of patients with PTC drains 2:

• Infectious complications (40.6%): cholangitis, sepsis, abscess formation
• Non-infectious complications (34.4%): bile leakage, hemorrhage
• Drain obstruction is a significant risk factor for infectious complications 2

Special Considerations

Signs of Drain Dysfunction:

• Decreased output
• Change in bile color or consistency
• Fever or signs of infection
• Pain around the insertion site
• Leakage around the catheter

When to Seek Medical Attention:

Patients should contact healthcare providers if:

• Fever develops (>38°C/100.4°F)
• Drainage significantly decreases or stops
• Pain increases around the insertion site
• Bile leaks around the catheter site
• Catheter becomes dislodged

Conclusion

Regular flushing of PTC drains is a critical maintenance procedure that helps prevent occlusion and associated complications. The procedure should be performed using sterile technique with normal saline, and patients or caregivers should be properly educated on the technique and signs of drain dysfunction.