The relevant factors and care involved in the removal of the T-tube can be managed by selecting stents or shame drainage according to the condition. During T-tube drainage, attention should be paid to protecting the T-tube to prevent it from falling out. In two cases where the T-tube came off, a doctor performed a sterile operation and reinserted a catheter through the original sinus V1 with one-time negative pressure, which was properly fixed, allowing continuous suction and smooth bile flow. Anti-inflammatory treatment, supportive care, and recovery were prescribed.
In diabetic care, due to delayed formation or poor formation of the duct, the removal of the T-tube is often postponed. Diet is particularly important for hypoglycemic treatment, including low-sugar or low-fat diets. Regular blood glucose monitoring and health guidance are essential to control sugar levels within an ideal range to facilitate sinus formation. Care must be taken during extubation to avoid forced removal that could cause sinus tears leading to bile peritonitis. Wound management and infection prevention are also emphasized.
For patients with liver dysfunction and ascites due to cirrhosis, T-tube drainage may reach 800-2000ml/day. To avoid excessive loss of bile from the common bile duct, jaundice should not raise the T-tube until postoperative days 5-7 when it can be elevated more than 30cm (or pinched). Nutritional support, protein supplements, and rest while avoiding drugs that harm liver function are advised.
In elderly patients with nutritional disorders, besides intravenous nutrition, they are admonished to eat a low-fat, high-protein diet to correct nutritional obstacles and improve their nutritional status, promoting sinus formation. Elderly patients may experience wound fat liquefaction caused by peritubular inflammation; hence, attention to nutrition, protection of the drainage area, skin cleansing, and dryness, as well as partial application of zinc oxide ointment, help prevent local skin ulcers and infections, resulting in good patient recovery.
Psychological care is crucial as most patients fear delayed extubation, anxiety, and mental concerns. They worry that long-term T-tube placement will affect their bodies, fear sudden detachment, and are concerned about inadequate T-tube care due to low educational levels and medical knowledge, potentially causing retrograde infections. Repeated psychological education is necessary, informing them about T-tube care, aseptic requirements, demonstrations, and teaching them to replace the drainage bag. Informing them to seek medical attention immediately if the T-tube falls off or if abdominal swelling, pain, redness, swelling, or pain around the tube occurs is critical. Regular telephone follow-ups alleviate their concerns, enabling better T-tube protection at home and preventing complications.
The main reasons for extending T-tube removal include incomplete solid formation of the sinus due to conditions like common bile duct stenosis, residual stones, edema or stenosis of Oddi’s sphincter, biliary pancreatitis, diabetes mellitus, biliary tract and gallbladder issues, liver dysfunction, cirrhosis, ascites, and low protein in blood syndrome. Other factors include malnutrition, age, and general condition, as well as T-tube material, drug effects, and iatrogenic causes. Understanding these reasons allows for anticipatory care measures such as controlling underlying diseases, focusing on T-tube observation and care (including self-care during hospitalization and discharge), better nutrition, rational drug use, and proper dietary guidance to reduce complications and improve quality of life. Extending T-tube removal increases mental suffering and economic burden, so good psychological care is also crucial.