What is an indwelling pleural catheter (IPC)?
An IPC is a soft, flexible, plastic tube which can be used to drain pleural fluid from the cavity between your lungs and rib cage (the pleural cavity).
It remains in place for as long as needed and avoids the need for repeated chest drains or needle drainages (aspirations) every time the pleural fluid builds up. IPC drainages are performed by a district nurse, or once the IPC is fully healed a friend or family member can be trained to do them, whichever you prefer.
One end of the IPC is placed inside the pleural cavity. The tube is then tunnelled under the skin (to minimise the risk of infection and to help keep it in place) and the other end comes out through the skin. There is a valve on the outer end of the tube to prevent fluid leaking out, and this is connected to a vacuum bottle to drain the fluid as often as required. The fluid is not drained continuously, so when it is not in use the valve is covered by a cap and the external section of the tube is curled up under a dressing.
Why do I need an IPC?
The pleural space consists of two thin membranes – one lining the lung and the other lining the chest wall. Between these layers there is a very small space which is usually almost dry. In your case fluid has collected in this space (a pleural effusion) so that the lung cannot function properly, making you short of breath.
Draining away the pleural fluid can help to relieve breathlessness for a period of time, but as the fluid re-accumulates it can make you short of breath again. The IPC is a way of allowing pleural fluid to be drained as often as needed at home without needing further needles or drains to be inserted into the pleural cavity.
Are there any alternative treatments?
Yes. It is possible to drain the pleural fluid using a needle which is inserted into the chest to remove the fluid each time it builds up. This is called a therapeutic aspiration. This can be done as often as needed, but can only be done in hospital. Each therapeutic aspiration may also be uncomfortable and is associated with risks including infection and bleeding.
Another option is to inject medical talc into the chest (talc pleurodesis). Talc works by irritating the inner and outer linings of the pleural cavity so that they stick together and pleural fluid can no longer collect there. It only works if the lung is able to re-expand so that the two pleural linings are touching after the fluid is drained. Therefore, it may not be an option for everyone.
The talc can be given either through a temporary chest tube, during a key-hole procedure called a thoracoscopy or through an IPC. If the talc is given through a temporary chest tube or thoracoscopy it will require you to stay in hospital for a few days. Talc pleurodesis is not successful for every patient.
How is the IPC inserted into the chest?
The IPC will usually be inserted as a day case, so you will not need to spend a night in hospital. You will be asked to lie in a comfortable position on your side and the doctor will perform an ultrasound scan of your chest to find the best place for the IPC to be inserted. A local anaesthetic will be injected into the skin to numb the place where the IPC will go. This can cause a stinging sensation but this quickly goes away.
Your doctor will then make two small cuts in the numb area of skin and create a tunnel for the IPC. One end of the catheter is placed into the pleural cavity, and the other end is passed through the tunnel and out through the skin.
This should not be painful, but you may feel some pressure and pulling. Two stitches are also applied when your tube is inserted; the district nurse will remove these about one week after the insertion.
After the procedure the chest may feel bruised and sore for about a week. We will provide you with painkiller medication to help relieve this discomfort. We advise against heavy lifting or strenuous activity for about two weeks while the area heals.
Important instructions to follow before your IPC insertion.
If you are taking any ‘blood thinning’ medications e.g. Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Dalteparin, Clexane injections, heparin injections, warfarin, or Clopidogrel, this must be discussed in advance with your hospital doctor. These medications must be withheld before an IPC insertion can take place. Your doctor will advise you when to stop them. These medications can be restarted once the IPC is in place.
How long do I have to stay in hospital?
Provided there have been no problems, the IPC insertion is done as a day case. After the procedure a chest x-ray will be performed and, after a short stay in the recovery area, you will be free to go home. Someone will need to drive you home.
Can I wash and shower normally?
In the 4 weeks after insertion the IPC must be kept dry, so your ability to wash and shower will be slightly restricted. Once the area is fully healed you will be able to bath and shower normally. We advise that the dressing should be replaced if it gets wet to minimise the risk of infection.
Who will drain the fluid from my IPC?
Drainage of the fluid is a straightforward procedure and can be performed by district nurses or anyone else who has been trained to do so. In the first instance we arrange for a district nurse to come to your home to perform the drainages.
However, it is possible for a friend or family member to receive training in performing the drainages if this is more convenient for you.
How will drainage bottles be supplied to me?
We will provide an IPC drainage bottle to take home with you when your IPC is inserted. Your IPC bottles will then be provided by the district nurses.
How long will the IPC be in place for?
IPCs are designed to remain in position for as long as they are needed. They can be removed when no more pleural fluid is being produced and they are no longer needed. For some patients this happens quickly, but some patients continue to produce pleural fluid and therefore continue to benefit from having the IPC in place.
If your drainage volumes significantly reduce and you have three consecutive drainages of less than 100ml, please contact the pleural team or lung cancer specialist nurses to arrange an appointment.
How often will the pleural fluid be drained?
Your doctor will discuss your IPC drainage options with you. Many patients start with drainages three times per week and this is usually enough to control their breathlessness symptoms. Around 25% of these patients will stop producing pleural fluid within the first 12 weeks, allowing for their IPC to be removed.
Recent research has shown that draining the IPC every day may help to reduce the amount of pleural fluid being produced in some patients. With daily drainages up to 45% of patients may stop producing fluid within the first 12 weeks, allowing for their IPC to be removed.
Can anything else be done to improve the chances of the IPC being removed?
Research has also shown that injecting medical talc through the IPC about 2 weeks after its insertion may also reduce the amount of pleural fluid produced. This can be done as a day case procedure in hospital. Up to 40% of patients who are given talc through their IPC stop producing pleural fluid within the first six weeks, allowing for their IPC to be removed. Talc is only effective if the lung is able to re-expand so that the two pleural membranes are touching after IPC drainage, so it may not be an option for everyone.
How is the IPC removed?
Generally it is a quick, straightforward procedure to remove an IPC. It may feel sore and bruised for around a week after it has been removed, but this can be treated with simple painkillers. There is a small risk of infection and bleeding but this is rarely serious.
Very occasionally it is not possible to remove the indwelling pleural catheter completely and the tip may be left inside the chest, although every effort will be made to remove it completely. If this happens it rarely causes any long-term problems, but you will be monitored closely by your doctor.
Who do I contact if I have queries or questions about my IPC?
Lung Cancer Nurse Specialists:
0117 414 1900
Louise Brennan (Secretary to Prof Maskell and Dr Clive):
0117 414 6337
Are there any risks involved with an IPC?
In most cases the insertion of an IPC is a routine and safe procedure. However, as with any medical procedure, there are some risks involved:
- Most people get some pain from their indwelling catheter in the first week and we will provide you with painkiller medication to help control this. Pain rarely persists but may do in less than 1 in 100 patients.
- Some patients experience pain or a dragging sensation when the IPC is being drained. This happens if the lung is unable to re-expand properly. This can usually be minimised by draining the fluid slowly and stopping as soon as you feel any discomfort.
- Sometimes IPCs can become infected but this is not very common, affecting less than 1 in 20 patients. Your doctor will thoroughly clean the skin and use sterile equipment when inserting the IPC to reduce the risk of infection. Once an IPC has been inserted this risk is minimised by good IPC care and hygiene, and we will teach you how to look after your IPC. You must tell your doctor if you develop a fever or notice any increasing pain or redness around the IPC. Infected IPCs rarely need to be removed but usually require admission to hospital and treatment with intravenous antibiotics. Every care is taken to secure an IPC in place, but occasionally accidents can happen and an IPC may become dislodged. Please let your team know if you have any concerns that your IPC may have become dislodged.
- During IPC insertion, a blood vessel may accidentally be damaged and cause serious bleeding. This affects less than 1 in 100 patients. This may (very rarely) require an additional procedure or operation to help stop the bleeding.
- Bands of fibrous tissue can form within the pleural fluid and cause it to develop into multiple smaller pockets (loculations), and this occurs in less than 1 in 7 patients. This can limit drainage volumes and cause increased breathlessness.
- When IPCs are used to manage pleural effusions caused by cancer, the cancer can begin to grow in the area around the IPC. This occurs in less than 1 in 20 patients. Please let your doctors know if you develop a lump or pain around your catheter in the weeks or months after it is inserted. If this problem does develop, your doctor will advise you on the appropriate treatment.
- Occasionally IPCs can become blocked by debris (less than 1 in 20). If this occurs, it can usually be unblocked by a member of the pleural team.
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
How to contact us:
0117 414 6337
© North Bristol NHS Trust. This edition published February 2020. Review due February 2022. NBT002498