Reading the drainage trend
After common bile duct exploration, a T-tube keeps the duct open and drains bile while swelling settles. Drainage of about 300–500 mL in the first 24 hours is expected; her 420 mL on day 1 is within that range. Output should then fall gradually as bile begins to flow into the duodenum. Day 2 shows exactly that: 360 mL of bile, light brown stool, and lighter urine, all signs that bile is reaching the intestine. On day 3, however, only 5 mL drained in 6 hours, and she has new right upper quadrant pain and a temperature of 38.0 °C. An abrupt stop in drainage with new pain and fever suggests the T-tube is blocked or dislodged.
Why it must be reported now
If the tube is obstructed or displaced, bile can no longer drain externally, and if the duct is not yet fully patent, bile backs up or leaks into the peritoneum. That can lead to bile peritonitis or cholangitis, both serious complications. The nurse checks the tubing for kinks and clamps, confirms the bag is below the insertion site, inspects the dressing for bile leakage, and reports the findings immediately. The tube is not flushed or irrigated without an order, because forcing fluid can push debris or bile into the tissues.
| Day | Bile output | Other findings | Interpretation |
|---|
| 1 | 420 mL | No stool | Expected (300–500 mL) |
| 2 | 360 mL | Light brown stool, lighter urine | Expected gradual fall; bile reaching gut |
| 3 (6 hours) | 5 mL | New RUQ pain, 38.0 °C | Abrupt stop: obstruction or dislodgement |
Why the other conclusions are wrong
Low output is expected only when it falls gradually with signs of bile reaching the gut and no new symptoms; an abrupt stop with pain and fever is different. The day 1 volume was not excessive, so it does not suggest a leak. Atelectasis can cause low-grade fever after abdominal surgery, but it does not explain the sudden loss of drainage or new right upper quadrant pain. Watch out! Distractors that explain only one finding are wrong when another option accounts for all the data together.
Exam takeaway
T-tube care includes keeping the bag below the insertion site, recording output every shift, protecting the skin from bile, and watching for sudden changes. Key point! A gradual fall in bile drainage is expected; a sudden stop with pain or fever is reported immediately.