Care of a Cholecystostomy Tube 

Purpose: 

To assure the patency of the cholecystostomy tube and assess, evaluate, and monitor drainage from the tube. 

Definition: 

A cholecystostomy involves creating an opening in the gallbladder to remove stones, bile, or pus. A tube is then sutured into the gallbladder for drainage, which is connected to a drainage bag or bottle. 

Equipment: 

• Gloves (1 pair sterile, 1 pair non-sterile) 

• Sterile 4x4’s 

• Tape 

• Normal saline 

• Any treatment ointments ordered by the physician 

Procedure: 

General Considerations: 

7. The nurse will monitor the cholecystostomy drainage tube each shift for patency and record the amount, consistency, and color of the drainage. 

8. The insertion site will be monitored at least each shift for signs and symptoms of infection. 

9. Dressings at the insertion site will be changed according to the physician’s order. The insertion site skin integrity will be monitored to maintain integrity. 

10. The drainage bag will be kept at or below waist level and emptied each shift by the nurse. 

11. Observe color changes in skin, sclerae, urine, and stool. 

12. Record vital signs each shift. 

Dressing Changes: 

13. Set up equipment. 

14. Gently remove the old dressing and discard the dressing and gloves. 

15. Inspect the site. 

16. Cleanse the site with normal saline. 

17. Apply treatment ointment as ordered. 

18. Cover with a sterile dressing and tape. 

19. Secure the tubing with tape to prevent it from being dislodged, ensuring patency and preventing obstruction. 

20. Keep the drainage bag at or below waist level. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the procedure, including the resident’s response, in their medical record. 

• Note any observations related to drainage, signs of infection, and skin integrity. 

• Regularly review and update techniques for caring for cholecystostomy tubes according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper cholecystostomy tube care procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.