Indwelling Pleural Catheter Home Guide Instructions

An indwelling pleural catheter is a thin, flexible tube that is inserted under your skin and into your chest. The catheter drains excess fluid that collects in the area between the chest wall and the lungs (pleural space).After the catheter is inserted, it can be attached to a bottle that collects fluid.

The pleural catheter will allow you to drain fluid from your chest at home on a regular basis (sometimes daily). This will eliminate the need for frequent visits to the hospital or clinic to drain the fluid. The catheter may be removed after the excess fluid problem is resolved, usually after 2–3 months. It is important to follow instructions from your health care provider about how to drain and care for your catheter.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Skin damage around the catheter.
• Lung damage.
• Failure of the chest tube to work properly.
• Spreading of cancer cells along the catheter, if you have cancer.

Supplies needed:

• Vacuum-sealed drainage bottle with attached drainage line.
• Sterile dressing.
• Sterile alcohol pads.
• Sterile gloves.
• Valve cap.
• Sterile gauze pads, 4 × 4 inch (10 cm × 10 cm).
• Tape.
• Adhesive dressing.
• Sterile foam catheter pad.

How to care for your catheter and insertion site

• Wash your hands with soap and warm water before and after touching the catheter or insertion site. If soap and water are not available, use hand sanitizer.
• Check your bandage (dressing) daily to make sure it is clean and dry.
• Keep the skin around the catheter clean and dry.
• Check the catheter regularly for any cracks or kinks in the tubing.
• Check your catheter insertion site every day for signs of infection. Check for:
  • Skin breakdown.
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

How to drain your catheter

You may need to drain your catheter every day, or more or less often as told by your health care provider. Follow instructions from your health care provider about how to drain your catheter. You may also refer to instructions that come with the drainage system. To drain the catheter:

1. Wash your hands with soap and warm water. If soap and water are not available, use hand sanitizer.
2. Carefully remove the dressing from around the catheter.
3. Wash your hands again.
4. Put on the gloves provided.
5. Prepare the vacuum-sealed drainage bottle and drainage line. Close the drainage line of the vacuum-sealed drainage bottle by squeezing the pinch clamp or rolling the wheel of the roller clamp toward the bottle. The vacuum in the bottle will be lost if the line is not closed completely.
6. Remove the access tip cover from the drainage line. Do not touch the end. Set it on a sterile surface.
7. Remove the catheter valve cap and throw it away.
8. Use an alcohol pad to clean the end of the catheter.
9. Insert the access tip into the catheter valve. Make sure the valve and access tip are securely connected. Listen for a click to confirm that they are connected.
10. Insert the T plunger to break the vacuum seal on the drainage bottle.
11. Open the clamp on the drainage line.
12. Allow the catheter to drain. Keep the catheter and the drainage bottle below the level of your chest. There may be a one-way valve on the end of the tubing that will allow liquid and air to flow out of the catheter without letting air inside.
13. Drain the amount of fluid as told by your health care provider. It usually takes 5–15 minutes. Do not drain more than 1000 mL of fluid. You may feel a little discomfort while you are draining. If the pain is severe, stop draining and contact your health care provider.
14. After you finish draining the catheter, remove the drainage bottle tubing from the catheter.
15. Use a clean alcohol pad to wipe the catheter tip.
16. Place a clean cap on the end of the catheter.
17. Use an alcohol pad to clean the skin around the catheter.
18. Allow the skin to air-dry.
19. Put the catheter pad on your skin. Curl the catheter into loops and place it on the pad. Do not place the catheter on your skin.
20. Replace the dressing over the catheter.
21. Discard the drainage bottle as instructed by your health care provider. Do not reuse the drainage bottle.

How to change your dressing

Change your dressing at least once a week, or more often if needed to keep the dressing dry. Be sure to change the dressing whenever it becomes moist. Your health care provider will tell you how often to change your dressing.

1. Wash your hands with soap and warm water. If soap and water are not available, use hand sanitizer.
2. Gently remove the old dressing. Avoid using scissors to remove the dressing. Sharp objects may damage the catheter.
3. Wash the skin around the insertion site with mild, fragrance-free soap and warm water. Rinse well, then pat the area dry with a clean cloth.
4. Check the skin around the catheter for signs of infection. Check for:
   1. Skin breakdown.
   1. Redness, swelling, or pain.
   1. Fluid or blood.
   1. Warmth.
   1. Pus or a bad smell.
5. If your catheter was stitched (sutured) to your skin, look at the suture to make sure it is still anchored in your skin.
6. Do not apply creams, ointments, or alcohol to the area. Let your skin air-dry completely before you apply a new dressing.
7. Curl the catheter into loops and place it on the sterile catheter pad. Do not place the catheter on your skin.
8. If you do not have a pad, use a clean dressing. Slide the dressing under the disk that holds the drainage catheter in place.
9. Use gauze to cover the catheter and the catheter pad. The catheter should rest on the pad or dressing, not on your skin.
10. Tape the dressing to your skin. You may be instructed to use an adhesive dressing covering instead of gauze and tape.
11. Wash your hands with soap and warm water. If soap and water are not available, use hand sanitizer.

General recommendations

• Always wash your hands with soap and warm water before and after caring for your catheter and drainage bottle. Use a mild, fragrance-free soap. If soap and water are not available, use hand sanitizer.
• Always make sure there are no leaks in the catheter or drainage bottle.
• Each time you drain the catheter, note the color and amount of fluid.
• Do not touch the tip of the catheter or the drainage bottle tubing.
• Do not reuse drainage bottles.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Take deep breaths regularly, followed by a cough. Doing this can help to prevent lung infection.

Contact a health care provider if:

• You have any questions about caring for your catheter or drainage bottle.
• You still have pain at the catheter insertion site more than 2 days after your procedure.
• You have pain while draining your catheter.
• Your catheter becomes bent, twisted, or cracked.
• The connection between the catheter and the collection bottle becomes loose.
• You have any of these around your catheter insertion site or coming from it:
  • Skin breakdown.
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Get help right away if:

• You have a fever or chills.
• You have chest pain.
• You have dizziness or shortness of breath.
• You have severe redness, swelling, or pain at your catheter insertion site.
• The catheter comes out.
• The catheter is blocked or clogged.

Summary

• An indwelling pleural catheter is a thin, flexible tube that is inserted under your skin and into your chest. The catheter drains excess fluid that collects in the area between the chest wall and the lungs (pleural space).
• It is important to follow instructions from your health care provider about how to drain and care for your catheter.
• Do not touch the tip of the catheter or the drainage bottle tubing.
• Always wash your hands with soap and water before and after caring for your catheter and drainage bottle. If soap and water are not available, use hand sanitizer.