5.4: Indwelling Pleural Catheter (IPC)
‘An IPC can be used as a ‘first choice’ treatment instead of a talc pleurodesis. It is also often used if a talc pleurodesis has been tried before but fluid has built up again to cause breathing difficulties, or if there is a ‘trapped lung’
Indwelling Pleural Catheter (IPC)
An IPC is a semi-permanent drain. It is a soft, flexible, plastic tube which can be used to drain pleural fluid from the chest. One end of the IPC is placed between the ribs, into the fluid. The middle part of the tube is 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. When the IPC is not in use, the valve is covered by a cap and the external section of the tube is curled up under a dressing.
An IPC is a way of managing pleural fluid rather than preventing it. By allowing the fluid to be drained as often as needed at home, people may avoid having to come into hospital for repeated procedures. For patients with ‘trapped lung’, IPCs can be an effective way to manage symptoms
Insertion of an IPC takes about 30mins and is performed as a day case, without an overnight stay. You will be asked to lie on your side in a comfortable position and an ultrasound will be used to mark the best place for the tube to enter the fluid. Local anaesthetic is used to numb the area where the drain is placed. Stitches will be used to hold the IPC in place while it heals and these can be removed, usually after 2-3 weeks.
Drainage of the fluid is a straightforward procedure and can be done by community nurses at your home or anyone else who has been trained to do so, including friends or family. A drainage bottle or bag is connected to the tube and the fluid is drained as often as required to keep your breathing as easy as possible.
How often to drain the fluid
This can vary from patient to patient. Your team of doctors and nurses will talk to you about what to do. It is usually done 2-3 times a week but can be more or less often. Each drainage usually takes 5-10 minutes but some people need to be drained more slowly than others. Caring for your IPC involves keeping it covered to ensure it is kept clean and dry to help prevent infection (see living with an IPC section).
IPCs are designed to remain in position for as long as they are needed. However, over time, having an IPC can eventually cause the lining of the lungs to stick together and prevent fluid from building up (‘self-pleurodesis’). Once the fluid stops building up, the IPC can usually be removed (see IPC removal section).
Self-pleurodesis occurs in about 1 in 5 (20%) patients.
Increasing the chance of Self-pleurodesis
It may be possible to increase the chances of self-pleurodesis and reduce the time taken for self-pleurodesis to happen (and so remove the IPC). A research study showed that draining the IPC more often (every day) can lead to self-pleurodesis in nearly 1 in 2 (45%) patients by 3 months, although draining this often can be hard for patients. Your doctors and nurses will talk to you about whether daily IPC drainage might be right for you
Self-pleurodesis can increase to nearly 1 in 2 (roughly 40-50%) patients with daily IPC drainages
Advantages
- Insertion of IPC is a short procedure which does not require an inpatient stay.
- An IPC is a good way of managing symptoms caused by fluid, such as breathlessness.
- An IPC can be the best option for some patients with a trapped lung.
- 1 in 5 may have a ‘self-pleurodesis’ allowing the drain to be removed (when the lung is not trapped)
- 1 in 2 may have a ‘self-pleurodesis’ with daily drainages (when the lung is not trapped)
Disadvantages
- Often limited to a maximal volume that can be drained during the procedure (could be important if there is a very large collection of fluid at the time)
- Requires regular drainages throughout the week either by the community nursing team or by a trained member of your family or friends. Daily drainages can be very demanding.
- It is a semi-permanent drain and can therefore have an impact on body image and undertaking hobbies, such as swimming
- An IPC doesn’t usually stop fluid forming (if this is a priority)
- A long-term drain carries a small risk of becoming infected (5-10%)
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Will this be painful?
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Does not usually cause pain. Sometimes a little painful when draining fluid if you have a trapped lung |
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Will I spend time in hospital?
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Done as a ‘day case’. There is no stay in hospital |
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Will I need to come back to hospital?
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Long term drains can have problems over time like blockages and infection Any complications can lead to hospital visits |
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Will I need further procedures?
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An IPC is a long term solution to control the fluid It is unlikely further procedures would be needed |
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What if my lung is trapped
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IPCs are the treatment of choice in trapped lung |
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Where can this be done?
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IPCs are not performed in all hospitals but are becoming available in more and more hospitals |
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Is there any aftercare?
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Long term drains require regular drainages at home which can be done by patients themselves, family members or community nurses |