Long term drains to treat ascites

Some cancers can cause fluid to build up in the tummy (abdomen). The medical name for this is ascites. It is pronounced ay-site-eez.

Normally you have a tube (drain) put into your abdomen to remove the fluid. This is called an abdominal paracentesis. The tube usually stays in for a few hours.

If the ascites comes back, your doctor may recommend you have a long term drain. This can stay in your abdomen for several months.

What is a long term drain?

A long term drain is a permanent tube that removes fluid from inside your body.

One end of the drain is in your abdomen. The other end is outside your body. When the fluid from your abdomen needs removing, you or your nurse connects a bottle to the end of the drain outside your body. The bottle has a vacuum that pulls the fluid into it.

You or your nurse remove the bottle when enough fluid has drained. When you are not using the drain, it is covered with a dressing. So you can’t see it under your clothes.

Having a long term drain means you don’t need to go to the hospital for a needle in your abdomen when you have a build up of fluid. You can manage the ascites from home instead.

Long term drains are sometimes called PleurX drains.

What happens before you have a long term drain put in?

The hospital will tell you how to prepare to have the drain put in. They may ask you to:

• stop eating and drinking
• stop taking some of your medicines
• have a blood test

Your doctor explains the procedure and what the possible risks are. They ask you to sign a consent form saying that you agree to it. You can ask them any questions you have. 

At the hospital, your nurse will ask you to change into a hospital gown and wear a hospital identification band. They might give you an antibiotic through a small tube (cannula) in your vein before the procedure. This is to stop you from getting an infection.

What happens when you have a long term drain put in?

You may go to the x-ray (radiology) department to have the drain put in. Or you might have it done in the operating theatre. 

Your doctor asks you to lay down and does an ultrasound scan of your abdomen. This is to help them find the best place for the drain. They may draw a mark on your skin where it will go.

They clean the skin on your abdomen and inject a local anaesthetic. This numbs the area. Once it’s numb they gently put a wire into your abdomen. This is used to guide the drain into the right place. It shouldn’t hurt but you may feel some pulling and pressure. Let your doctor know if this is uncomfortable. 

Your doctor makes 2 small cuts in the skin of your abdomen. One cut where the wire is, the other is above it. They pass the drain through the top cut, and under the skin to the wire. They then thread the drain down the wire and into your abdomen. When the drain is in, they remove the wire.

The drain has a cuff that sits under the skin. This keeps it in place. But your doctor also puts some stitches in to stop it moving.

Once the drain is in, they attach a special bottle to the end of the drain and remove any fluid that is in your abdomen.

When the fluid has finished draining, your doctor removes the bottle and puts a cap on the end of the drain. They also put a dressing over the top.

What happens after you have a long term term drain put in?

You go back to the ward. Your nurse checks your blood pressure and pulse regularly. They also check the dressing.

You usually go home the same day. Or you might need to stay overnight.

Before you go home your doctor or nurse will tell you:

• when you can shower, and if you can have a bath while you have the drain
• when the stitches need to be taken out, and who will do it
• the signs of infection to look out for
• if you need to take antibiotics at home, and how to take them

Draining the fluid

Your nurse might ask if you can drain the fluid yourself. Or if you have a friend or relative that can do it. If you can, they will show you how to do it.

If you can’t do it yourself, or don’t have anyone to help you, they will arrange for a nurse to come to your home to drain it.

Draining the fluid yourself

Before you go home your nurse will teach you how to drain the fluid.

They will give you some dressing packs. These have everything you need to drain the fluid.

Then they will show you how to:

• wash your hands properly
• get the dressing pack ready
• clean your abdomen
• connect and remove the bottle
• put the dressing on afterwards

When fluid builds up, you take the cap off the end of the drain and attach a clean bottle.

It usually takes between 5 and 15 minutes to drain the fluid. But your doctor or nurse will tell you how long to keep the bottle connected, or how much fluid to drain.

After the fluid has drained, you remove the bottle and put a new cap on the end of the drain. You also put a clean dressing on.

Ask your nurse how you get rid of the used bottles, and where you get more dressing packs.

Possible risks and complications of a long term drain

Having a long term drain put in is generally safe. But all medical procedures have some risks or complications. Your doctor makes sure the benefit of having the drain outweighs these risks.

Pain and discomfort

You may get some pain or discomfort for a couple of days after you’ve had the drain put in. Mild painkillers should help. Changing your position can also make you more comfortable.

Infection

Sometimes you can get an infection in the cuts made to put in the drain, or in the your abdomen. If you get an infection your doctor will give you some have antibiotics. These might be as tablets or through a drip. 

Call your 24 hour advice line straight away if:

• you have a high temperature - also called a fever
• the skin around the drain is red or swollen
• you have abdominal pain
• the fluid draining into the bottle changes colour

If you get a severe infection, your doctor might need to take the drain out.

Fluid leak

Sometimes you might get fluid leaking around the stitches. Let your doctor or nurse know if this happens. It might mean the stitches need to stay in a bit longer.

Bleeding

Rarely you might get some bleeding. Your doctors and nurses look out for this during and after the procedure.

The drain becomes blocked or falls out

If the fluid stops draining it might be caused by a blockage. Try changing your position or sitting upright. This can sometimes move the blockage. If not, let you doctor know as soon as possible. You will become uncomfortable if the fluid can’t drain. You may need to have the drain taken out.

Also tell your doctor or nurse if the drain falls out or you think it has moved.

If the drain needs to be removed or falls out your doctor might talk to you about whether you have another one. Ask your doctor if you have any questions about this or if you have any concerns.