Information leaflet for patients with ascites in advanced liver disease needing an indwelling (Rocket) peritoneal catheter

What is an indwelling peritoneal catheter? (IPeC)

An indwelling peritoneal catheter, or abdominal drain, is a specially designed small tube to drain fluid from around your abdomen easily and painlessly whenever you require. It avoids the need to insert a drain every time the fluid collects. You can either perform the drainage on your own or with the help of a nurse. The tube is soft, flexible and about the size of a thin straw in diameter. One end remains inside the abdomen and the other passes out through the skin. There is a one-way valve on the end which prevents fluid leaking out of the tube.

Why do I need an IPeC?

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

What can be done to help?

The indwelling catheter is a way of allowing fluid to be drained repeatedly without the painful drainage procedures and without having to come to hospital.

How is the indwelling catheter put in?

The pleural team will do this in hospital. They will ask you to lie in a comfortable position. They will clean your skin with a liquid cleaner to kill any bacteria and inject an anaesthetic into the area to numb the place where the indwelling catheter will go. This can sting but the discomfort passes off quickly. The doctor will then make two small cuts in the numb area of skin 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 that you do not feel it 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 very rarely some patients may stay in hospital overnight.

How does the drain stay in position?

Indwelling catheters are designed to be a permanent solution to the problem of ascitic fluid building up (though they can be removed if they are no longer needed).

There is a soft cuff around the tube which 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. These will be removed by your nurse after seven to 14 days.

Who will drain the fluid from my indwelling catheter?

Drainage of the fluid is easy. The nurse specialist will be able to teach you, a relative or a friend, how to drain the fluid so that it you can do it in the comfort of your own home. You will get illustrated instructions which take 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. Otherwise you could visit the outpatient department where the nurse specialist or one of the clinic staff can perform the drainage for you.

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 rate of re-accumulation varies between people and 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 but you will be guided by your nurse or doctor.

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 drain. We also routinely give antibiotics for seven days after 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, including 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 after insertion a dressing will be placed on the catheter. We advise you to keep this dry until the stitches are removed seven days later. Providing the site is then clean and dry, you will be able to shower normally, but bathing and swimming are not considered safe as the site where the drain passes out of the skin could let contaminated water into the abdomen.

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.

Use of Human Albumin Solution

Patients will have a discussion with the hepatology team about whether the use of Human Albumin Solution (HAS) is needed. Not having HAS is known to have a long term negative effect on prognosis and renal function and the effects of this will be discussed in detail so that you can make an informed decision. If you do decide to have HAS then you will need to come to hospital once a week for drainage of your ascites and HAS replacement.

What should I do if something happens to the tube?

On discharge from hospital you will be given information dealing with after care following tube insertion.

How to contact us / further information

If you would like any further information about this procedure, or if any problems arise, you can telephone Pleural Service on 01223 349189, Monday to Friday from 08:00 - 18:00.

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.