What is an Abdominal PleurX?
An abdominal PleurX is a small, flexible catheter (tube) that is placed in the peritoneal space of your abdomen and used to remove peritoneal fluid (ascites). The PleurX™ drainage system lets you take control of uncomfortable and painful symptoms from pleural effusions or ascites. A safe, proven option that more than 500,000 patients have used since 1997, the PleurX system helps you drain fluid buildup in the comfort of your own home.
How does the PleurX system work?
The PleurX system includes a drainage catheter and drainage bottles that collect fluid. The catheter is inserted, typically as a simple outpatient procedure, in the chest for draining pleural effusions or in the abdomen for malignant ascites. The end of the catheter stays outside of the body, hidden under a bandage when not in use. To drain, just connect the end of the catheter to the drainage line on the bottle, following the PleurX drainage procedure directions for use, and the bottle will automatically draw out the fluid.
What does a PleurX system look like?
There will be a catheter exiting the skin in the front of the abdomen. It is a soft catheter and does not interfere with sleeping. Usually the skin heals around it like “an earring” and there is no pain in the site after a few days.
Would you benefit from an Abdominal PleurX?
You developed ascites for reasons that we may or may not know. This fluid can cause you to have distention of your abdomen, abdominal pain, constipation, and sometimes difficulty breathing, especially when you walk or do any sort of activity.
You may or may not have had a paracentesis before where ascites is drained out of your abdomen. Paracentesis is a simple procedure where a needle is punctured into the abdomen under ultrasound guidance, into the peritoneal space where the ascites is, and fluid is drained out. Even though the procedure is done with local anesthetic and is tolerated well with minimal pain, it can be inconvenient, especially if you have to have it done multiple times in a month. It may be more convenient for you to have an abdominal PleurX catheter so you can drain fluid off in the comfort of your home and as frequently as you need.
How is the Abdominal PleuRx placed?
The procedure is performed at El Camino Hospital in the radiology department. An entire team will be taking care of you during the procedure including a radiology nurse, a radiology technologist and the physician. In the Interventional Radiology procedure room, the nurse will help you lay on an exam table. You will be connected to heart rate, blood pressure and oxygen saturation monitors. Medicine may be given to relax you through your IV called moderate, also known as “twilight,” sedation. Your procedure area will be prepped and sterilized. A numbing medicine will be injected into the area (local anesthetic). Using imaging guidance, the peritoneal cavity will be visualized a small puncture will be made through the skin, into the abdomen and peritoneal space. A guidewire will then replace the needle and the needle will be removed. Another puncture will be made a couple inches from the guidewire and the PleurX catheter will be tunneled just under the skin to the guidewire. This tunneling helps anchor the catheter in place. The PleurX catheter will then go over the guidewire into the abdomen and the guidewire is removed. The tube exiting your skin will be temporarily sutured in place and your initial puncture site will be sutured closed. Your PleurX catheter will then be connected to a vacuum bottle and the ascites will be drained off. After completion, your PleurX catheter and procedure site will be securely dressed and bandaged with a water sealed dressing.
The procedure time usually takes about 15-30 minutes. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.
What can you expect after the procedure?
After the procedure you will go to the post-surgical area for recovery where we will be able to monitor your vital signs and the site of the procedure. In general, you will be there for 30-60 minutes. We want to be sure you do not have any problems before you go home.
Don’t worry. You will be able to eat and drink right after the procedure. You also will be able to see your family members soon after the procedure. If you feel well enough, you will be able to go home.
At home, we recommend that you take it slow the remaining day of the procedure. You should not drive, operate heavy machinery or consume alcohol until the following day after the procedure if you received sedation.
You will be discharged with a PleurX kit that comes with extra bottles and written instructions along with a CD with a video tutorial on how to care for and drain your PleurX at home. Additional supplies will be mailed to your home, but if you ever need more, please contact us at 650-404-8445.
We recommend you follow-up the next few days for PleurX teaching so we can instruct you and any family members on drain site care and how to use PleuRx.
How long does it take to recover?
Most patients should be able to return to their normal activities the day after the procedure.
We recommend no contact sports or extraneous activity for a period of approximately 1 week post procedure to minimize the chance of bleeding.
What are the potential complications/risks of the procedure?
There is a small risk of an infection at the site. Although it is possible to happen it is fairly rare. If an infection happens it may need to be treated with antibiotics or the tube may need to be removed.
The tube could accidentally come out. It has a cuff that your skin heals around it and prevents from being easily removed. However, if the tube gets pulled or dislodged, there is no need for panic. You can just put a bandaid over it. Call your interventional radiologist during normal hours to determine if the tube needs to be reinserted.
Can I take a shower with the catheter in place?
Yes. Initially, it should be covered with plastic. However, after 1 week you can get the site wet. After 2 weeks you can potentially go to the hot tub or swimming pool without problems. After the contact with the water, the tube site should be dried off with a towel and a new dressing should be applied.
How do I drain the fluid myself?
Your doctor or nurse will train you on using the PleurX drainage bottles. Basically, you will simply connect the end of the tube to the drainage line on the PleurX drainage bottle. The bottle contains a vacuum that automatically draws out the fluid through the catheter. A caregiver can also help you drain the fluid.
What do I do with the fluid after it is removed?
The fluid can be disposed of in the toilet with double flushing.
What should you watch for?
You may be sore after the procedure. However, the pain should not be getting worse and should subside in 2-3 days. However, these are the things you should watch for:
Increased abdominal pain or abdominal distention
Redness or increased tenderness at the catheter insertion site
Fluid or pus leaking around the catheter insertion site
If you notice any of these issues or have any questions or concerns please contact us at 650-404-8445.
If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may shower 24 hours after the procedure.
You may use over the counter medication such as Acetaminophen (Tylenol) or ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at (650) 404-8445.
While this is controversial, no one really has a good reason why you cannot shower with your PleurX catheter. So we suggest that you do NOT shower the day of the procedure, but can shower the next day as long as you try to keep the catheter insertion site dry while you shower for the first two weeks. During this time you should not soak the catheter or the insertion site in water (eg. bath and swimming pool). Each kit should have clear plastic dressing that can create a water-tight seal around your catheter.
During the first 2 weeks you should cover your PleurX catheter with the plastic dressing provided with the kits (or any plastic sealing dressing) while you take a shower.
After 2 weeks the catheter site should be adequately healed, so if it gets wet it should not be a problem. Just be sure to blot the site dry and place a new dressing.
If the dressing gets wet during shower, dry the area around the catheter and apply a new dressing.
What if I have questions about using my PleurX catheter?
You can call the Interventional Radiology Clinic M-F from 8am till 5pm if you have questions. An appointment will be made to review use of the catheter and give you any additional information.
You can reach your Interventional radiologist at 650-404-8445 during M-F 8-5pm, or the physician can be reached through the operator after hours or on weekends by calling 408-739-6000 and asking for the Interventional Radiologist “on call.”
PleurX catheter placement: https://www.youtube.com/watch?v=wmMo9NFftLE
PleurX drainage procedure: https://www.youtube.com/watch?v=VMr11BXbip4