Patient Information (v1 24.12.12)

What is an indwelling pleural catheter?  An indwelling pleural catheter (IPC) is a specially designed small tube which drains fluid from the area around your lungs called the pleural space. The IPC stays in place permanently or for as long as needed, so that the fluid can be drained easily and avoids further invasive procedures, for example the repeated use of needles to drain the fluid.

Why do I need an IPC?  The pleural space is the space between the lung and the inner lining of the chest. These layers lie very close together but pleural fluid can accumulate in the space, called a pleural effusion. This can affect the usual function of the lungs and cause shortness of breath.

What are the alternatives to IPC?  Draining the fluid can help relieve the breathlessness but the fluid can return. Whilst it is possible to have repeated drainage with chest tube insertion, this can be uncomfortable, carries risks and requires repeated hospital admissions. The IPC is a way of allowing fluid to be drained painlessly, as often as necessary and without having to come to hospital. 

Talc pleurodesis is a procedure to stick the layers of the outer lung and inner chest wall together to stop the build up of pleural fluid. This is a procedure carried out in hospital and you would need to stay for up to 4-6 days.

How is the IPC put in place?  The insertion of the IPC is carried out in hospital. You will be local anaesthetic to make the procedure more comfortable and antibiotics to reduce the risk of infection if thought necessary by the doctor.

You will be asked to lie in a comfortable position. Sedative medication may be given through a needle in the back of your hand to make you feel drowsy. An ultrasound scanner is used to help guide the procedure.

Your skin will be cleaned with a cold solution to kill any bacteria. A local anaesthetic is then injected into the skin to numb the area where the IPC catheter will be placed. This can sting but the discomfort passes off quickly. The doctor will then make two small cuts in the numb area of skin and open a path for the indwelling catheter. This should not be painful although you will feel some pressure or tugging. One cut is for the catheter to pass through the skin and the second is for it to be passed into the chest. The indwelling catheter is then eased into the pleural cavity.

Will it be painful?  Local anaesthetic is injected into the skin before the drain is put in so that you do not feel the drain going in. You are also given painkilling medication to control any pain. At the end of the procedure your chest may feel bruised or sore for about 2-3 days and this can be controlled with painkillers if necessary.  

How long do I stay in hospital?  Usually patients can leave hospital the same day the IPC is put in place. Sometimes you may be kept in hospital overnight .

How does the drain stay in place? There is a soft cuff around the tube which is positioned under the skin. As the skin heals the drain becomes more secure. Two stitches will be put in when your tube is inserted. These will be removed by your nurse after 10 to 14 days at which time the tube will stay in place on its own.

How is the fluid drained? The drainage can be performed by you, a family member, or with the help of a nurse. The tube is soft, flexible and about the width of a pencil. One end stays inside the chest and the other passes out through the skin on the side of your lower chest. There is a one-way valve on the end which stops fluid leakage and prevents air going into the tube. Silver Chain nurses can be organised to come to your home to drain the fluid. Drainage can be a part of your clinic visit and the staff can teach your carer to do home drainage.

How often does the fluid need to be drained?  When your catheter is inserted the doctor will remove most of the fluid from your chest cavity at the same time. The rate of the fluid returning is different between people; some patients need daily drainage whilst others require only weekly drainage or less. You can drain fluid as often or as frequently as is needed and you will be guided by your nurse or doctor.

Are there any risks with IPC insertion?  In most cases the insertion of a chest drain and its use is routine and safe. There are small risks, like all medical procedures. All of these can be treated by your doctors and nurses:

  • Most people get some aches from their indwelling catheter in the first 2-3 days. This can be controlled with simple painkillers.
  • Sometimes indwelling catheters can become infected but this is uncommon (affecting about 1 in 70 patients). The main risk is infection entering the chest down the    tube. The risk is minimised by careful cleaning of the catheter which you will be taught how to look after.
  • The site should be checked daily for signs of infection such as redness, swelling, oozing and whether you have pain or a fever – if this does occur you should inform your Silver Chain nurse or respiratory doctor as soon as possible as you may need a course of antibiotics.
  • Every time a pleural drainage procedure is performed there is a possibility that it may cause bleeding which may require further procedures to stop it. This probably only affects about 1 in 500 people However, having an IPC reduces the number of pleural drainages needed and this lessens the overall risks ,
  • Sometimes cancer tissue can affect the area around the indwelling catheter. Please let your doctor know if you develop a lump, or any pain, around your catheter in the weeks after it is inserted. If this happens the cancer tissue can easily be treated with radiotherapy.
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    Can I wash and shower normally?  After insertion of the IPC a dressing is placed over the catheter. The outpatient clinic will provide you with shower covers which go over the IPC dressing. We ask you to keep this dry until the stitch is removed seven days later. Providing the stitch site is clean and dry, you will then be able to bath and shower normally.

    When is the indwelling catheter taken out?  IPCs are designed to stay in position in the body. However, sometimes the fluid drainage from the chest dries up and the catheter is no longer needed. In this situation the catheter can be removed. You will be asked to come into hospital and the tube will be removed as a day case procedure.

    What should I do if something happens to the tube?  On discharge from hospital you will be given information about how to look after the IPC.

    How to contact us / further information  If you would like any further information about this procedure, or if any problems arise, you may telephone either: (08) 9346 1754 or 0421253918.

     

    (Adapted from the Respiratory Medicine, Cambridge University Hospitals (UK), Indwelling Pleural Catheter – Information for Patients.)