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Date issued: August 2022

For review: August 2024

Ref: B-145 v2  Indwelling Pleural Catheter Insertion final August 2022 v2.pdf [pdf] 313KB

Indwelling Pleural Catheter Insertion Information for patients

Provisional appointment date & time: _____________________________

Your responsible (lead) consultant is: _______________________________

Important information about your procedure

• Please report to _________________________ward with this information leaflet on the date and time above. Please ensure you leave enough time for your journey to the hospital.

• Please tell the doctors and nurses looking after you about any medical conditions you have, and all the medication you take.

• Please tell us if you take any medication to thin the blood; these may need to be stopped before your procedure. You must continue to take any other medication as normal.

• Please seek medical advice if you develop any shortness of breath or increasing chest pain after your procedure.

Please sign and date below to confirm that you have read this information leaflet in full. You will have the opportunity to discuss any questions you might have about the procedure, or any other aspects of your treatment, with a doctor when you come to hospital for your appointment.

Signature:  __________________________________________________

Print name: __________________________________________________

Date: __________________________________________________

What is an Indwelling Pleural Catheter (IPC)?

An IPC is a small tube designed to fit between your ribs into your chest cavity. It is tunnelled underneath the skin before entering the chest cavity so that it sits comfortably on the side of your chest and minimises the risk of infection getting into the chest space. When not in use this tube can be coiled up under a plaster on the side of your chest. However, community nurses have been trained to attach a drainage bottle to this tube so that you can have fluid drained from around your lungs at home. This helps to prevent multiple trips up to the hospital and is designed for patients that get recurrent build-up of fluid around their lungs.

Why do I need an IPC? Are there alternative procedures available?

The space in your chest cavity is naturally lubricated by a small amount of fluid. In some patients the amount of fluid within the space can accumulate. There are many causes for this. However, some patients have recurrent build-up of fluid in this space and find that drainage of the space helps their symptoms. There are several ways of managing recurrent fluid around the lungs.

An IPC

Your doctor has recommended an IPC as a way of controlling any symptoms you might be experiencing. An IPC can be inserted to drain the fluid around your lungs and you can expect to go home the same day with the tube in place. If your fluid recollects quickly or you have ‘trapped lung’ this drainage tube can help. An IPC allows the fluid to be drained at home. Some patients will need it draining every day and others much less frequently. We aim to keep the space dry and free of fluid. With this approach many patients find that with time, the amount of fluid decreases and they need less regular drainage. Some patients can have the drainage tube removed as it is no longer needed. However, the tube is designed to stay in for as long as you need it.

Diuresis

Some patients have build-up of fluid in their chest secondary to problems with their heart, liver or kidneys. These patients can be managed with diuretics (medication that helps to clear the fluid from your body so that it does not build up around the lungs). Your doctor may rarely recommend an IPC in this situation if the fluid cannot be controlled with medication.

Recurrent aspiration of the fluid

Some patients may undergo recurrent pleural aspiration. This procedure enables fluid to be drained from the chest cavity, but the drainage tube is removed soon after insertion. Your doctor may try this to manage the fluid initially. However, if your fluid builds up again quickly after this procedure, a more permanent solution is required to avoid repeating this frequently. Your doctor wants to minimise the number of procedures you have.

Chest drain and pleurodesis

Some patients do not like the idea of always having a chest tube in place at home. Another option is to have a temporary chest drain inserted to allow all of the fluid to drain out of the space around the lungs. This requires admission to hospital and you would be expected to remain on the ward for at least 2 days. Once the fluid has emptied, patients will then have an injection of talc (a sterile talcum powder), into the chest tube, to stick the lung up against the chest wall. This is called pleurodesis. This can stop the fluid re-occurring with a success rate of between 60 and 80%.

This is only an option for patients whose lung re-expands to touch the chest wall after drainage of fluid. Some patients have ’trapped lung’ (the lung does not re-expand) and this procedure will not work for them.

If you have any concerns or questions, please let your doctor know and they will be happy to discuss things with you in more detail. Your doctor will have considered your procedure carefully, and made their decision with your best interests in mind. However, it is ultimately your decision as to whether or not you wish to have the procedure done.

How should I prepare for my IPC?

• Please let us know in advance if you are:

  • Pregnant

  • Taking medication to thin your blood

If any of these apply to you, we will need to make special arrangements for your procedure. These may include instructions as to what you should do with your medication.

• Please bring the following items with you on the day of your procedure:

• reading glasses, if you need them

What should I do with my medications?

It is important to let us know in advance if you are taking medication to thin the blood. These will need to be stopped temporarily before your procedure can go ahead. Your procedure may need to be cancelled if you do not follow these instructions.

Please take your other medication as normal.

The tables below explain what you should do with your medication in more detail. Please contact your doctor if you are not sure what to do. If your blood thinning medication cannot be stopped then your doctor may change it to an alternative medication temporarily, to enable the procedure to take place.

Medication                              Instructions

 Warfarin                                           Stop 7 full days before your procedure. You will need to have an INR blood test with your GP or at the hospital 1-2 days                                                                   before your procedure to make sure your INR is less than 1.5; otherwise we may need to cancel your procedure.

Aspirin                                              Stop 1 full day before your procedure.

 

Clopidogrel (Plavix)

Dipyridamole (Persantin)                   Stop 7 full days before your procedure

Ticagrelor (Brilique)      

 

Apixaban (Eliquis)

Dabigatran (Pradaxa)

Edoxaban (Savaysa)                        Stop 2 full days before your procedure.

Rivaroxaban (Xarelto)

 

Dalteparin (Fragmin)

Enoxaparin (Clexane)                          Stop 1 full day before your procedure.

Tinzaparin (Innohep)

What will happen on the day of my procedure?

You will be contacted by the team to inform you of the precise time and location of your procedure in advance. You will be greeted by a member of the team, who will check your observations (e.g., heart rate, blood pressure, temperature) and go through a checklist with you. This will include questions about your medical history, medications, and allergies.

A member of the team may take some blood tests if these have not been checked in advance. The procedure will be explained to you in more detail, and you will be asked to sign a consent form to confirm you are happy to go ahead.

A doctor will do an ultrasound scan of your chest to help decide where to insert the IPC safely. An ultrasound scan involves placing gel and a hand-held probe over your skin to create a picture on a screen, with you lying on your side. The ultrasound scan should not be painful. The doctor will then inject local anaesthetic into your chest wall, this may sting at first, but will soon numb the area so you do not feel anything during the procedure.

Once the area is numb, the doctor will be able to insert the tube. Your doctor will create a small tunnel for the tube to sit under your skin before directing it into the fluid in your chest cavity. You may feel a pushing sensation as the drain is inserted but it shouldn’t feel sharp or painful. Once the IPC is correctly sited it will be held in position with two stitches and a dressing.

These stiches can be removed by the district nurse team in 3-weeks’ time. Your doctor will arrange for the district nurses to come and drain the fluid three times a week initially but this can then be titrated to your symptoms.

What are the risks of the procedure?

IPC insertion is generally a very safe procedure, and serious complications are rare.

• Pain

You will experience pain in association with the procedure, but this is rarely severe. There is likely to be discomfort associated with the local anaesthetic and after the procedure the site may feel bruised. It is normal for your chest to be sore whilst the drain is in your chest for a week or so after your procedure; this can be managed with painkillers. Some patients will feel their chest is tight and they may have a cough for a few days following the procedure, if a larger volume of fluid is drained. Your doctor will control the amount of fluid that is drained from your chest to minimise this side effect.

• Infection

There is a low but important risk of introducing an infection following an IPC insertion. This can usually be treated with antibiotics. Very rarely, infections can be more serious and need surgical treatment (an operation). Your doctor will take precautions during the procedure to ensure that this risk is minimised. The district nurses will look after the drainage tube to ensure they minimise the risk of introducing infection up the tube during drainage. They will also dress the tube with clean dressings each time they visit.

• Bleeding

A small amount of bleeding at the site of the procedure is normal. However, a small amount of people have significant bleeding during their procedure. This can usually be managed at the time of the procedure, but very rarely surgical treatment (an operation) is required.

• Injury to underlying organs

Your doctor will use an ultrasound scanner to locate the fluid for the procedure to minimise risk of damage to organs. However, there is a risk that the needles used to insert the drain can damage the lung, liver, spleen or heart. This may require a hospital stay or a surgical procedure. Very rarely patients have died from chest tube insertion. Your doctor will take every precaution to minimise the risk of any damage.

• Blockage of the drainage tube

Sometimes patients re-present as their drainage tube has become blocked. Usually your doctor can unblock the tube using a special medication that breaks up any debris in the IPC. However, this would mean travelling up to the hospital to have this resolved. You can expect to go home the same day. Very rarely the tube cannot be unblocked and is removed.

• Development of a loculated space

Some patients develop a loculated space in their chest cavity. This can happen in patients with an IPC and without one. Loculation is where your body creates walls within the space in your chest, separating the fluid into multiple pockets (similar to the honeycomb in a bee hive). When this occurs it may be difficult to empty the fluid from the space, as if your drainage tube sits in one pocket it may not be able to drain the adjacent one. If the drainage tube is not helping your doctor may suggest it is removed.

• Track metastasis

Some patients with cancer in their chest cavity can have spread of cancer cells around the chest tube in the skin along the insertion site. It is rare for this to happen and your doctor will take precautions to help prevent this.

What happens after the procedure?

The team will arrange for you to have a chest x-ray. If you are in any discomfort, we will give you painkillers to manage this. You must let your nurse and/or doctor know if your chest becomes increasingly painful or you feel increasingly short of breath. If you feel ok after the procedure then you will be allowed home. Your doctor will give you the first 3 drainage bottles to take home with you and will contact the district nurses to arrange the visits for the fluid to be drained.

How long does my IPC have to stay in?

The length of time your IPC needs to remain in for varies amongst all our patients. The drain is designed to stay in for as long as you need but if the cavity stops producing fluid we can arrange to take the drain out.

Pleural Secretary:

Tel: (01752) 431496

Respiratory Fast Track Coordinators

Tel: 01752 763863

In the event of an emergency, please contact your on-call GP or NHS 111 for further advice