Procedure: PleurX tunneled peritoneal drainage catheter placement with ultrasound and fluoro with large volume paracentesis
Indication: Ascites.
Date:
Operators: Drs.
Medications: mg IV Versed, mcg IV fentanyl and 1 g IV Ancef
Albumen: g IV
Catheter: 15F PleurX Catheter
Specimen: liters
Access site: quadrant with ultrasound
Complications: None immediate.
Technique:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. The specific risks of bleeding, infection, and damage to adjacent bowel loops were detailed and accepted. Written informed consent was obtained. A timeout was performed.
The anterior abdominal wall was prepped and draped in sterile fashion. Ultrasonographic evaluation was carried out, and an appropriate entry site identified in the . Using local anesthetic and ultrasound guidance, the peritoneal space was accessed with a 21 gauge needle. Clear yellow fluid was returned. Needle entry was documented, and images transferred to PACS.
A 0.018” wire was placed through the needle, and the needle exchanged for a 5 French transitional dilator. The smaller wire was replaced with a short Amplatz wire. The skin tract was dilated and a 16 French peel-away sheath placed over the wire.
The soft tissues cephalad and medial to the sheath entry site were anesthetized with 2% lidocaine with epinephrine. A dermatotomy was created, and the PleurX catheter was pulled through the tunnel with the tunneling device. The cuff was positioned in the of the tunnel.
The intraperitoneal wire and dilator were removed, and the catheter was placed through the peel-away. It was positioned using fluoroscopy. The peel-away was removed.
The peritoneal puncture site was closed in two layers with 4-0 absorbable suture and Dermabond. Steri-Strips were applied. 2-0 Ethilon sutures were placed at the tunnel exit site to secure the catheter. A sterile dressing was applied.
Subsequently, large volume paracentesis was performed through the newly placed catheter. A total of liters clear yellow fluid were removed.
The procedure was well tolerated, and the patient was discharged in satisfactory condition.
Findings:
- There is ascites.
- The peritoneal catheter is positioned .
- Total volume removed was .
Impression:
Tense ascites.
Uneventful image guided placement of 15 French multi sidehole PleurX intraperitoneal catheter to facilitate frequent large volume paracentesis.
__ liters clear yellow fluid were removed without incident.
Arrangements were made for supply access and patient/caregiver teaching.
Frequently Asked Questions
What is a PleurX tunneled peritoneal drainage catheter used for?
A PleurX tunneled peritoneal drainage catheter is used to manage ascites, which is the accumulation of fluid in the peritoneal cavity, often due to conditions like liver disease or cancer. The catheter allows for regular drainage of this fluid at home, preventing discomfort and complications associated with fluid buildup.
How is a PleurX catheter placed?
The placement of a PleurX catheter involves using ultrasound and fluoroscopy for guidance. After obtaining consent, the anterior abdominal wall is prepared, and a needle is used to access the peritoneal space. A series of dilators and wires are used to position the catheter correctly, which is then tunneled under the skin and secured with sutures to minimize infection risk.
What are the risks of PleurX catheter placement?
The risks associated with PleurX catheter placement include bleeding, infection, and potential damage to surrounding bowel loops. However, these risks are minimized through careful imaging guidance and sterile technique. Patients are informed of these risks before the procedure, and consent is obtained.
Is the PleurX catheter placement procedure painful?
The procedure is generally well-tolerated with minimal discomfort. Local anesthetics and sedation, such as Versed and fentanyl, are used to alleviate pain and anxiety during the procedure. Some patients may experience mild discomfort, but it is usually manageable.
Large volume paracentesis is a procedure in which a significant amount of fluid is removed from the peritoneal cavity. It is often performed to relieve symptoms of ascites, such as abdominal swelling and discomfort, and can also help in diagnosing the underlying cause of fluid accumulation.
How do patients care for their PleurX catheter at home?
Patients are taught how to manage their PleurX catheter at home, including how to perform drainage, maintain catheter site cleanliness, and recognize signs of infection. Regular follow-up with healthcare providers is essential to ensure proper function and address any complications.
What does 'tunneled' mean in the context of a PleurX catheter?
In the context of a PleurX catheter, 'tunneled' refers to the method of placing the catheter under the skin through a subcutaneous pathway before it enters the peritoneal cavity. This technique helps secure the catheter, reduces infection risk, and provides a stable access point for fluid drainage.
What should patients expect after a PleurX catheter placement?
After placement, patients may experience mild soreness at the insertion site, which usually resolves in a few days. They should monitor for signs of infection, such as redness or fever. Regular drainage as instructed by healthcare providers will help manage symptoms of ascites effectively.