A tunnelled indwelling pleural catheter is a specially designed small tube to drain fluid from around your lungs easily and painlessly whenever it is needed.

It avoids the need for repeated hospital attendance, painful injections and insertion/ removal of chest tubes every time fluid needs to be drained.

The drainage can be performed either by you on your own or by a nurse in your own home.

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The pleural space lies between the layers covering the lung and chest wall. Normally very little fluid is present to help with friction during breathing.

But in your case fluid has collected in this space in excess due to underlying disease preventing the lung expanding as a result, this is making you breathless.

Breathlessness can be relieved by draining away the fluid completely by inserting a chest tube or aspirating it to a maximum of 1.5 litres. It’s quite possible the fluid will re-accumulate.

The above procedures can be repeated but this is uncomfortable, carries risks and frequent hospital admissions or clinic appointments.

The indwelling pleural catheter allows your fluid to be drained more frequently in your own home.

The tube will be put in the hospital as a day case procedure in the Pleural clinic procedure room. You may be offered painkilling medication to make the procedure more comfortable.

You will be asked to lie on your side. Chest ultrasound will be performed to locate a suitable site to insert the IPC. Your skin will be cleaned with a liquid cleaner to kill any bacteria, which often feels cold. An anaesthetic is then injected into the skin to numb the place where the indwelling catheter will go. This can sting but the discomfort passes off quickly.

The doctor will then make two small cuts in the numb area of skin and gently open a path for the indwelling catheter. This should not be painful although you will feel some pressure or tugging.

One cut is for the catheter to pass through the skin and the second is for it to be passed into the chest. The indwelling catheter is then eased into the chest.

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Adequate painkillers and local anaesthetic will be given to you so you will not feel any pain. At the end of the procedure your chest may feel ‘bruised’ or ‘sore’ for about a week but this can be controlled with pain relief medication tablets.

This procedure is generally done as a day case and you may need to be monitored for a few hours, so some patients may stay in hospital over-night.

The tube has a cuff as shown on the picture on page 5, which is placed under the skin. This generates an inflammatory response to which the skin heals and holds the drain.

The healing takes place within 7 to 14 days.

Until then the drain is secured using two sutures, which are removed by your Nurse after 7 to 14 days.

This drain is designed for long term use but can be removed if no longer needed.

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Drainage of the fluid is a straightforward procedure.

We will arrange for a member of the District Nurse team to do this for you at home.

The District Nurses may be able to teach you, a relative or a friend, how to drain the fluid so that it can be done in the comfort of your own home.

You will be given illustrated instructions on how to do this which clearly takes you through the procedure step by step.

When the catheter is inserted the Doctor will remove some of the fluid from your chest cavity at the same time.

Initially the District Nurses will drain the drain three times a week to start.

The rate of re- accumulation varies between people and some patients need daily drainage whilst others require only weekly drainage or less. You can drain fluid as frequently as is needed but you will be guided by your Nurse or Doctor.

In most cases the insertion of a chest drain and its use is routine and safe.

However, like all medical procedures, chest drains can cause some problems. All of these can be treated by your Doctors and Nurses.

Most people get some pain or discomfort from their indwelling catheter in the first week. Pain relief medication will control this.

Sometimes indwelling catheters can become infected but this is uncommon (affecting about 1 in 50 patients). Your Doctor will clean the area thoroughly before putting in the chest drain to try and prevent this and we will teach you how to keep your catheter clean. Tell your Doctor if you feel feverish or notice any increasing pain or redness around the chest drain.

Very rarely, during the insertion, the chest drain may accidentally damage a blood vessel and cause serious bleeding; this probably only affects about 1 in 500 patients. Unfortunately, if it does happen it is a serious problem which requires an operation to stop it.

Generally indwelling catheters are very well tolerated.

The main risk is infection entering the chest down the tube. The risk is minimised by good catheter care and hygiene. You will be taught how to look after your catheter. The site should be checked regularly for signs of infection (redness, swelling, oozing, pain or fever) – if this does occur you should inform your District Nurse, GP as soon as possible so that you can be assessed and if necessary receive treatment with antibiotics.

Sometimes cancer tissue can affect the area around the indwelling catheter. Please let your Doctor know if you develop a lump, or any pain, around your catheter in the weeks after it is inserted.

Initially after insertion there will be a dressing placed on the catheter and we advise you to keep this dry until the stitch is removed 7 days later.

Providing the site is then clean and dry, you will be able to bath and shower normally.

Indwelling catheters are designed to remain in position permanently.

However, sometimes the fluid drainage from the chest dries up and the catheter is no longer needed. In this situation the catheter can be removed as a day case procedure.

If you have any concerns about your tube please contact the Respiratory Secretaries on 01253951638 / 01253953735

If you require urgent assessment of the tube (for example sudden bleeding from the drain, sudden pain or signs of infection) please attend A&E.