PleurX Drainage Catheter Insertion

• Infection
• Tuberculosis
• Cancer – of various types – lung and metastatic from other malignancies
• Renal and liver pathologies which cause fluid accumulations in the body

This depends on the cause of fluid collection. Sometimes the fluid gets dried up with medicines alone. If not, then fluid may have to be collected for testing, called diagnostic tapping. If there is lot of fluid, then it may have to be drained completely which is called therapeutic tapping. In case of recurrent repeated accumulation of fluid, it may require placement of a tube in the chest.

These include - 

• Pigtail catheter – a small 1-3 mm tube, with tip shaped like a pigs tail placed in the fluid.
• Malecot catheter – size is the same as a pigtail, however, the shape is different, the tip is the shape of a flower.
• ICD – Basically, the term ICD stands for intercostal drainage tube. Although technically both pigtails and malecots are also intercostal drainage tubes, when we use the term ICD, it generally signifies a wide bore tube with side holes, which is generally placed surgically using an incision, cut and sutures.
• Permenant drainage/indwelling catheters/pleurx – the above mentioned tubes are temporary tubes, generally placed for 2-3 weeks. The disadvantage of these temporary tubes is that they can slip out and always require an underwater seal/bag to be attached to the tube for fluid drainage. To counteract these issues, a permanent indwelling catheter was introduced called pleurx, which is especially useful in cases of recurrent and repeated fluid accumulations.

Pleurx drainage catheter is a small tube that interventional radiologists place within patients pleural space to drain fluid. This is a patented product by the BARD/BD system. It is a permanent chest tube placed in the pleural space. Around 10 cm of the tube are placed under the skin (making it permanent, wherin a cuff is present to cause tube adherence to the skin and preventing accidental removal).

Indications of Inserting Pleurx

Pleurx catheter is generally placed for recurrent or repeated pleural effusions i.e. when repeated tappings are required. 

Common indications include:

• Malignant pleural effusion i.e Effusion in lung cancer patients or due to secondary malignancies i.e metastatic. Oncology related effusions are the most common indications.
• Recurrent pleural effusions not responding to medical management.
• Pleurx is indicated for palliation of dyspnea because of pleural effusion & providing pleurodeses (resolution of pleural effusion).

The procedure takes about 45-90 minutes. Procedure is done by an interventional radiologist and is done under USG guidance. Sometimes, fluroscopy assistance is also required.

• The procedure is done under local anesthesia. If needed, mild sedation can also be given.
• You will be brought into the procedure room.
• You will be screened with USG. The presence of effusion shall be confirmed.
• You will be given a shot of local anesthesia near the area where your catheter will be inserted.
• Once the area is numb, the interventional radiologist will make 2 small incisions, one will go through your skin into the pleural space, second will be a few cms away (approx. 10 cm away) and will only involve skin.
• A tunnel will be made between this two incisions under your skin.
• Once the tunnel is formed, pleurx catheter will be advanced into the pleural space through the tunnel.
• A cuff (on the tube) is placed in this tunnelled space. The cuff gets fibrosed into the skin and subcutaneous tissue. The presence of the cuff makes this tube permanent.
• Stitches are taken to close the incisions & fix the catheter.
• A dressing will be put over the catheter's exit site.

• Inspect your catheter every day.
• Drain the fluid as directed by your primary physician. Detailed explanation as to how the catheter is to be used during home care shall be explained. Multiple videos and training demos are available for its direction of use as well.
• Change the dressing after every use.
• Check for bends (kinks) in your catheter.

How much fluid to drain? how to monitor?

Your primary physician will tell you how much fluid to drain & at what frequency. Don’t drain more than 1 litre in one sitting unless your doctor tells you to do so. Each time you drain your pleurx catheter write down following things - 

1. Date & time

2. Amount of fluid drained

3. Colour

4. Any symptoms

Can I take a shower with the catheter in place? 

Yes you can take a shower the only condition the self adhesive dressing received from the drainage kit should be implied on the skin and after that you can get shower. If the goss pad becomes wet when showering remove the dressing immediately clean up and dry up the area, imply a new dressing provided in the drainage kit. Pleurx catheter system has been designed in way to allow you to manage your fluid accumulation in the comfort of your home.You will be easily trained by our experienced doctors and nurses about how to use the items given in your pleurx drainage kit. 

Is pleurx catheter only used in chest for pleural effusion?

No, pleurx catheter has a kit for ascites also, it is used to drain fluid accumulating in the abdomen. This catheter is also called a pleurx catheter, although it is placed in the abdominal space. The size of the catheter is different. Rest of the tube details are more or less similar. Technique of placement and usage are also the same.

When & how will I know about removal of catheter?

When fluid is not draining for 3-4 consecutive times and also when you have no symptoms of breathlessness or your oncological treatment is complete, you should give your doctor a visit to find out if the catheter can be removed or should be replaced.

What should I do if the colour of the fluid drained changes?

If the colour of the fluid drained changes, inform your doctor regarding the same.

Can my catheter get infected? How will I come to know?

Yes there is a possibility of catheter getting infected in the long run. You should contact your doctor immediately if your believe your catheter is getting infected. Redness (erythema), warm, swelling, fever or drainage from around the catheter site may indicate your catheter is infected. Some minor amount of redness after the procedure is expected. But it should not persists.

Can pleurx catheter be accidentally pulled out?

The pleurx catheter has a polyester cuff which is placed underneath the skin when the catheter is inserted. This cuff along with the sutures helps keeping the catheter in place. But very unlikely event of catheter if its pulled out, cover the site with sterile dressing and seek your doctors help.