Indwelling peritoneal catheter (IPeC)

What is an indwelling peritoneal catheter?

An indwelling peritoneal catheter is a specially designed small tube to drain fluid from around your abdomen easily and painlessly whenever needed. It avoids the need for repeated ascitic drain insertion every time the fluid collects. The drainage can be performed on your own or with the help of a nurse. The tube is soft, flexible and about the size of a pencil in diameter. One end remains inside the abdomen, and the other passes through the skin. There is a one-way valve on the end which prevents fluid from leaking out of the tube

Why do you need an IPeC?

Fluid can accumulate in the abdomen for many reasons. The presence of this fluid can become quite uncomfortable and possibly cause other complications. Draining the fluid can relieve the pressure exerted by the fluid and make you feel more comfortable.

What can be done to help?

The re-accumulating fluid can be drained traditionally with repeated insertions of an ascitic drain, but this can be uncomfortable, carries risks and requires repeated hospital admissions. The indwelling catheter allows fluid to be drained repeatedly without painful drainage procedures or having to come to the hospital.

How is the indwelling catheter put in?

The tube will be inserted in the hospital. You will be asked to lie in a comfortable position. Your skin will be cleaned with a liquid cleaner to kill any bacteria. An anaesthetic is then injected into the skin to numb the place where the indwelling catheter will go. This can sting, but the discomfort passes quickly. The doctor will then make two small cuts in the numb skin area and gently 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 abdomen. The indwelling catheter is then eased into the abdomen.

Will it be painful?

Local anaesthetic is injected into the skin before the drain is put in, so 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 abdomen may feel ‘bruised’ or ‘sore’ for about a week, but this can be controlled with painkilling tablets.

How long do I stay in hospital?

This procedure is generally done as a day case, but some patients may stay in the hospital overnight.

How does the drain stay in position?

Indwelling catheters are designed to permanently solve the problem of ascitic fluid building up (though they can be removed if they are no longer needed). A soft cuff around the tube is positioned under the skin, to which the skin heals, making the drain more secure. Two stitches will be put in when your tube is inserted. Your nurse will remove these after 14 days.

Who will drain the fluid from my indwelling catheter?

Drainage of the fluid is a straightforward procedure. There are several ways this can be done. First, the specialist team will be able to teach you, or a relative or a friend, how to drain the fluid so that it can be done in the comfort of your own home. You will be given illustrated instructions on how to do this, taking you through the procedure step by step. Alternatively, we will arrange for a member of the district nurse team to do this for you at home.

How often does the fluid need to be drained?

When your catheter is inserted, the doctor will remove most of the fluid from your abdominal cavity at the same time. The re-accumulation rate varies; some patients need daily drainage, while others require only weekly drainage or less. You can drain fluid as often or as frequently as is needed, but your nurse or doctor will guide you.

Are there any risks with indwelling catheter insertion?

In most cases, the insertion of an abdominal drain and its use is routine and safe. However, like all medical procedures, ascitic drains can cause some problems. All of these can be treated by your doctors and nurses:

• Most people get some pain or discomfort from their indwelling catheter in the first week. Painkilling medication will control this.
• Sometimes indwelling catheters can become infected, but this is uncommon (affecting about 1 in 50 patients). Your doctor will clean the area thoroughly before putting in the abdominal drain to try and prevent this, and we will teach you how to keep your catheter clean. Tell your doctor if you feel feverish or notice any increasing pain or redness around the chest drain. We also routinely give antibiotics for seven days post-insertion.

Very rarely, during the insertion, the drain may accidentally damage a blood vessel and cause serious bleeding. This probably only affects about 1 in 500 patients.

Are there any risks associated with long term indwelling catheter use?

Generally, indwelling catheters are very well tolerated.

• The main risk is infection entering the abdomen down the tube. The risk is minimised by good catheter care and hygiene. You will be taught how to look after your catheter. The site should be checked regularly for signs of infection (redness, swelling, oozing, pain or fever). If this does occur, you should inform your district nurse, GP or pleural nurse specialist as soon as possible so that you can be assessed and, if necessary, receive treatment with antibiotics.
• 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.

Can I wash and shower normally?

Initially, a dressing will be placed on the catheter after insertion, and we advise you to keep this dry until the stitch is removed seven days later. Providing the site is then clean and dry, you will be able to shower normally. Unfortunately, we do not advise that the drain is immersed in water: swimming or bathing.

When is the indwelling catheter taken out?

Indwelling catheters are designed to remain in position permanently. However, sometimes the fluid drainage from the abdomen dries up, and the catheter is no longer needed. In this situation, the catheter can be removed as a day-case procedure.

What should I do if something happens to the tube?

Upon discharge from the hospital, you will be given information about aftercare following tube insertion.

How to contact us / further information

If you would like any further information about this procedure, or if any problems arise, please telephone the pleural service on 01223 349189, Monday to Friday 08:00-18:00 hours.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one to one care is required.