What color should drainage be from a percutaneous cholecystostomy drain?

Expected Drainage Color from Percutaneous Cholecystostomy

Normal percutaneous cholecystostomy drainage should be bile-colored (green to golden-brown) initially, then transition to serous (clear to pale yellow) fluid as inflammation resolves, with output decreasing to less than 30-50 mL per day before considering drain removal.

Initial Drainage Characteristics (First 24-48 Hours)

• Bile-colored drainage (green, golden-brown, or dark yellow) is expected initially as the gallbladder decompresses 1, 2
• Clinical resolution of sepsis occurs within 24-48 hours in approximately 92% of patients, with corresponding changes in drainage character 3, 2
• The volume may be high initially but should progressively decrease as inflammation resolves 2

Evolution of Drainage Over Time

• Transition to serous fluid (clear to pale yellow) indicates resolution of acute inflammation and is the goal before drain removal 2, 4
• Output should fall below 30-50 mL per day of serous fluid for at least three consecutive days before considering removal 2, 4
• This transition typically occurs over 4-6 weeks as the gallbladder inflammation resolves 2, 4

Abnormal Drainage Colors Requiring Immediate Attention

Bloody or Hemorrhagic Drainage

• Frank blood or bloody output suggests bleeding from liver parenchyma (most common with transhepatic approach) or vascular injury 1, 2
• Monitor hemoglobin and vital signs for hemodynamic instability 1
• While typically self-limited, persistent bloody drainage warrants imaging evaluation 1

Purulent or Cloudy Drainage

• Thick, purulent, or cloudy drainage indicates ongoing infection or abscess formation 1
• Send bile cultures to guide antibiotic therapy adjustments 2
• Rising inflammatory markers (WBC, CRP) with purulent drainage suggests inadequate source control 1, 2

Feculent or Foul-Smelling Drainage

• Feculent material or foul odor raises concern for hollow viscus perforation, particularly colon injury with transperitoneal approach 1, 2
• Requires immediate CT imaging and surgical consultation 1

Daily Monitoring Algorithm

• Record drain output volume, character, and color daily to track clinical progress 1, 2
• Inspect the drain site for erythema, purulence, or dislodgement 1, 2
• Perform abdominal examination for new peritoneal signs that could signal bile leak 1, 2
• Obtain serial laboratory tests (LFTs, WBC, CRP); rising bilirubin or persistent leukocytosis suggests ongoing obstruction or infection 1, 2

Critical Pitfalls to Avoid

• Do not assume clear drainage means the drain can be removed early—tract maturation requires a minimum of 4-6 weeks regardless of drainage character 2, 4
• Never remove the drain without cholangiography at 2-3 weeks confirming cystic duct patency and free duodenal flow 2, 4
• Sudden cessation of drainage may indicate catheter obstruction from debris, clots, or kinking rather than resolution—flush the catheter and assess patency 1
• Persistent bile-colored drainage beyond 4-6 weeks suggests cystic duct obstruction and requires cholangiography before removal 2, 4