Day #1 PTC with 8 fr or 10 fr PBD Admit

Day #2-3 Biliary tube upsize to 12 fr discharge home if stable

Week #3-4 biliary tube upsize to 14 fr Bentec 1-2 weeks w/possible cholangioplasty

Week # 5-6 biliary tube upsize to 16 fr Bentec 1-2 weeks w/possible cholangioplasty

Week#7-8 biliary tube upsize to 18 fr 1-2 weeks w/possible cholangioplasty

Once the patient has an 18 fr, | bring them back in 3 months for tube change and upsize to 20fr if they have COOK drain . If they have 18 fr Bentec, they will return in 3 months for tube change.

6 months Amplatz anchor trial 1 week
6 months +1 week Whitaker Test

If pass -> tube removal
If fail -> surgical repair or chronic intubation

1. Drain to gravity bag x 24 hrs then cap if no fevers, pain or discharge at entrance site
2. Patients should be discharged each visit with an extra drainage bag, cap and prescription for 10cc NS flushes
3. Each drain should be flushed BID with 10cc NS
4. If a patient has a cholangioplasty with a cutting balloon, use a 7 or 8mm cutting balloon
5. Any sign of cholangitis, patient should be admitted (transplant for transplant patients or hospitalist for other patients)
6. End goal is 18 fr Bentec or 20 fr COOK
7. Protocol is designed for 6 months intubation with large tube (18 fr or larger)

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