11: Why Might I Need My Indwelling Pleural Catheter (IPC) Removed? 

Sometimes, removing your indwelling pleural catheter (IPC) becomes necessary; while this might sound unsettling, the procedure is usually straightforward and quick. There are several reasons why this might have been recommended to you.

• Resolution of your Pleural Effusion: If the fluid buildup around your lungs has improved—possibly due to treatments like talc pleurodesis, daily drainages or ‘self-pleurodesis’ (see indwelling pleural catheter section) — then the drain is no longer providing any benefit (fluid drainage) then it would simply be an infection risk and should therefore be removed.

• Infection: There is a small risk of infection (either superficial around the skin or deeper within the fluid itself) with an IPC (see indwelling pleural catheter section). In the majority of cases infection can be managed with antibiotics and without the need for the drain to be removed. However, there may be circumstances where the drain is removed to help treat the infection. If you still need ongoing drainage, it may be possible to reinsert the catheter after successfully treating the infection. In the meantime, your pleural effusion can be managed in other ways.

• Catheter Damage: If the catheter becomes fractured or damaged, it may be repairable, but in some cases, removal is required. Once the fluid has accumulated again, a new catheter can be inserted if needed.

• Catheter dislodging. The IPC is held in place by a small cuff around the tube that attaches to the tissues underneath to skin (this is at the part of the drain that tunnels under the skin). Overtime the cuff can become dislodged and the IPC can start to slowly slip out. If this happens, it might be best to remove the drain. It may be possible to reinsert the catheter in the future and in the meantime, your pleural effusion can be managed in other ways.

• Blocked IPC: If the catheter becomes blocked (this is rare) then your doctors or nurses can try flushing the drain or can sometimes use a special medication through the drain to dissolve the blockage. If this fails, the catheter might need to be removed though this is very rare.

How do I know if the pleural effusion has resolved?

Most commonly you will see the volume of fluid drained on each attempt getting smaller and smaller. When there has been less than 50mls (millilitres) drained on three consecutive drainage attempts then you could contact your doctor and nursing team that inserted the drain to see if it is time to consider removing it.

What Happens During the Removal Procedure?

Removing your IPC is typically a quick and simple procedure. Here’s what you can expect:

• Preparation: You’ll be asked to avoid blood-thinning medications before the procedure, just as you did when the catheter was initially placed. However, no other special preparations are needed. Feel free to eat and drink as usual, if you feel up to it. You can go home afterwards. The procedure is done as an outpatient, meaning you won’t need to stay in the hospital.

• Before the Procedure: A chest X-ray may be taken to check before removal, although in most cases, a thoracic ultrasound is sufficient to assess the chest. This is mainly to ensure the drain isn’t blocked rather then the pleural effusion resolving.

• Positioning: Just like when the catheter was initially inserted, you’ll be asked to lie on your unaffected side.

• Anaesthesia: The area around the catheter will be cleaned, and a sterile drape will be placed over it. A local anaesthetic will then be injected around the skin and the drain site to numb the area. You might feel a small sting, but you shouldn’t feel any sharp sensations once the anaesthetic takes effect.

• Removal of the Catheter: a small incision may be needed to remove the catheter. Sometimes, the tube needs to be gently loosened (the cuff needs to be gently ‘dissected’ to free it from the tissue). Once the catheter is out, the incision will be closed with sutures. You’ll be informed about when the sutures should be removed, either by community nurses or community team, or at the Hospital clinic.

After the Procedure: What to Expect

Once the catheter is removed, you may spend a short time under observation to ensure everything is okay. If all is well, you can go home to rest.

• Discomfort: It’s normal to feel some mild discomfort around the site where the catheter was. If this occurs, painkillers like paracetamol and ibuprofen can help manage the pain.

Signs to Watch for After the Procedure

It’s important to keep an eye out for any signs that something might not be quite right. If you notice any of the following, please contact the hospital team right away:

• Increased pain, redness, or swelling around the where the drain used to be.

• New fever, chills, or other signs of infection.

• Difficulty breathing, chest pain, or shortness of breath.

• Any unusual discharge, such as pus, from the wound where the drain used to be

Potential Risks and Complications

While the removal of your IPC is generally a quick and low-risk procedure, there are some potential complications to be aware of:

• Infection where the drain used to be.

• Reaccumulation of fluid or air in the pleural space.

• Bleeding or discomfort during removal.

• Difficult removal & drain fracture: In rare cases, the drain may not be easily removed. Whilst trying to remove a drain it is possible the drain might ‘fracture’ or snap leaving part of the drain inside. Every effort is made to avoid this but if it does happen then this should not cause any long term problems. As long as the skin can be closed (with stitches) where the drain used to exit the body, then the skin will heal and the risk of infection will no longer be there.

If You Have Concerns:

If you’re feeling uncertain about anything or have questions, please don’t hesitate to contact your team. It’s important that you feel fully informed and comfortable with the process.