Guide to Indwelling Pleural Catheter

An indwelling pleural catheter (IPC) is typically needed for patients with recurrent pleural effusions, such as those caused by cancer or certain infections, who require ongoing drainage to relieve symptoms like shortness of breath or chest pain. These patients may have failed or be unsuitable candidates for other treatments like repeated thoracentesis or pleurodesis, making IPC insertion a viable option for long-term management of their pleural effusion. IPCs allow for regular drainage of fluid from the pleural space at home, offering improved quality of life and symptom control for these individuals.

Read on as we tackle some common questions associated with IPC.

Understanding the Indwelling Pleural Catheter

1. What is an indwelling pleural catheter (IPC) and why do I need one?

An indwelling pleural catheter (IPC) is a soft, flexible plastic tube positioned at the side of your chest, facilitating the easy removal of accumulated fluid between your lungs and rib cage, aiming to alleviate shortness of breath caused by chest fluid buildup.

Since fluid often reaccumulates after drainage, the IPC remains in place for as long as necessary, allowing for easy fluid removal without the need for hospitalization or uncomfortable medical procedures.

When not in use, the IPC is capped and covered with a clean flat dressing, ensuring it remains discreet under loose clothing and does not disrupt your daily activities.

2. What are the risks associated with IPC?

While IPC placement is generally safe and straightforward, potential issues include manageable pain, typically controlled with local anesthesia and pain medication, and minor bleeding that usually stops without intervention; severe bleeding requiring additional procedures or surgery is rare.

The main risk associated with IPCs is infection, affecting about 1 in 50 patients, which can often be treated successfully with antibiotics without the need for IPC removal. To minimize infection risk, it's crucial to handle the IPC and conduct fluid drainage in a clean environment, emphasizing strict hand hygiene and proper technique.

3. Are there any alternative treatments?

Yes, alternative treatments include pleural tap (thoracentesis), a relatively safe outpatient procedure involving needle insertion through the chest to remove fluid. However, this procedure needs to be repeated with each fluid reaccumulation, potentially leading to multiple interventions and increased risks of complications such as pain, bleeding, and infection.

Another option is temporary chest drain insertion, similar in complication risks to IPC placement but requiring hospitalization for complete fluid drainage and usually removal before hospital discharge. Administering talc into the chest cavity via the chest drain can reduce fluid reaccumulation, with a success rate of approximately 70%, contingent on adequate lung expansion post-drainage.

4. What happens after the IPC is placed?

After IPC placement, you'll be monitored for a few hours, and if there are no complications, you may be discharged from the hospital with a family member or caregiver accompanying you home.

If you're hospitalized during IPC insertion, monitoring will continue in the hospital post-procedure. Our nurses will organize a meeting with you and your caregiver to provide guidance on IPC care, either during your hospital stay or at an outpatient review, ensuring you're equipped to manage the IPC properly.

How IPC Drains Fluid

1. Who will drain the fluid from my IPC?

Fluid drainage from the IPC is a straightforward procedure that can be conducted with the assistance of a caregiver in the comfort of your home, utilizing drainage bottles or bags. We will provide thorough training to you and your caregiver on safe fluid drainage techniques, typically taking 5 to 15 minutes to complete.

After drainage, disconnect the collection device, dispose of the used bottle in a waste bag, and cap the IPC, covering it with a clean, flat dressing.

The frequency of drainage varies among patients, often guided by symptoms such as shortness of breath or chest discomfort, with some requiring daily drainage and others once every 1 to 2 weeks. Increasing drainage frequency may reduce fluid accumulation rates and potentially allow for IPC removal, a decision your doctor or nurse will discuss with you.

Watch how IPC care and fluid drainage works in the videos below.

Drainage Bottle

Drainage Bag

2. What should I do if I still feel short of breath after draining fluid?

Avoid draining more than 1000 ml of fluid from the chest per day, as persistent shortness of breath may indicate factors beyond chest fluid accumulation. Inform your doctor or nurse if symptoms persist after drainage.

3. It gets painful whenever I am draining fluid from my IPC, what should I do?

Discomfort during fluid drainage is common but can be minimized by draining slowly and stopping at the first sign of discomfort. With vacuum bottle drains, adjust the flow using the control unit, fully releasing the button or slider to stop drainage and resume when comfortable.

Persistent pain after drainage cessation warrants contacting your doctor or nurse as soon as you can.

4. Can the IPC ever be removed?

Although IPCs are intended for permanent placement, diminished chest fluid accumulation over time may render the IPC unnecessary, prompting its removal as a day case procedure.

If fluid drainage volume decreases or stops entirely, ensure the IPC isn't obstructed and notify your doctor or nurse if drainage volume decreases abruptly or remains consistently low.

Caring for Your IPC

1. What do I need to monitor or look out for?

Keep a record of the date and amount of fluid drained, reporting any changes in fluid color or appearance to your doctor or nurse. Change the IPC dressing weekly and immediately if it becomes soiled, wet, or loose. Symptoms such as fever, increasing redness, pain, swelling, or fluid discharge around the IPC site may indicate infection, requiring prompt medical attention.

2. Will the stitches be removed?

Two stitches are applied during IPC insertion, with one typically removed 7 to 10 days later during a scheduled review. The second stitch, securing the IPC, can be removed after a few weeks by a community nurse, doctor, or nurse in a family clinic or polyclinic.

3. Can I wash and shower normally?

For the first 7 to 10 days after IPC insertion, keep the IPC site dry until the first stitch is removed. You can shower with the IPC under a waterproof dressing, ensuring it's securely attached, and all components are contained underneath. Change the dressing if it gets wet, cleaning and drying the area before applying a new one.

4. What should I do if the IPC is accidentally cut or damaged?

If the IPC is cut or damaged, clamp it close to the skin using the emergency blue clamp from the procedure pack to prevent air or fluid leakage, and notify your doctor or nurse immediately.

5. What happens if the IPC is accidentally pulled out?

The IPC has a soft cuff under the skin that helps secure it in place as the skin heals around it. If the IPC is dislodged or partially pulled out, cover the exit site with a clean dressing and seek immediate medical attention.

6. Can I continue to drain fluid from my IPC if I am admitted to another hospital?

Yes, an adaptor IPC line allows easy connection to other drainage devices used in local hospitals.

7. Who should I contact for help and advice?

Regular follow-up appointments will be provided to monitor IPC function and assess for complications. Contact us promptly if you experience any issues with your IPC.

Frequently Asked Questions about Indwelling Plural Catheter.pdf