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A Drainage Catheter with a Uresil Disk

This information will help you prepare for the insertion of your drainage catheter with a uresil disk at Memorial Sloan Kettering Cancer Center (MSKCC) and teach you how to care for it at home.

Introduction

You will have a procedure to place a catheter to drain fluid. This booklet will describe:

  • The purpose of the catheter
  • How it will be inserted
  • How to care for it at home

The Collection Drainage Catheter

The purpose of a drainage catheter is to drain a collection of fluid in your body. When this fluid is infected, it is called an abscess. An abscess may cause fever, pain, or abnormal blood tests. You may or may not have symptoms if the fluid is not infected.

A drainage catheter is inserted through the skin and into the area where fluid has collected. The catheter will be secured to your body with a disk. Fluid will drain from the catheter into a small bag.

The catheter will be removed when the fluid is gone and any infection is cleared.

Insertion of The Drainage Catheter

The catheter is inserted by a doctor in Interventional Radiology. It generally takes less than one hour. The doctor will explain the procedure. You will then have time to ask any questions before you sign a consent form.

After the procedure, the catheter is attached to a bag. The amount of drainage in the bag depends on many things. Your doctor can give you an idea of what to expect.

Preparing for Your Procedure

Often, drainage catheters are placed urgently when you are sick. In some cases though, you will be scheduled to come into the hospital for the procedure. If this is the case, please follow these guidelines:

  • Do not take aspirin or any products that contain aspirin for five days before the procedure. Review the aspirin card. This card is available at Pre-Admission Testing or from your doctor's office. It tells you what products have aspirin and anti-inflammatory drugs.
  • Ask your doctor what to do if you take:
    • Blood thinners such as warfarin (Coumadin®), clopidogrel (Plavix®), or cilostazol (Pletal®)
    • Medication for diabetes
  • Call your doctor if you develop any illness a day or two before your procedure. This includes a fever, cold, flu, or a sore throat.
  • Do not eat solid food after midnight the night before your procedure.
  • You may continue to have clear liquids up to one hour before your procedure. These include:
    • Water
    • Apple or cranberry juice
    • Coffee or tea without milk
    • Jell-O®

If you are coming in from home for your procedure, you will receive 2 telephone calls 1 business day before your procedure. If your procedure is on a Monday, you will be called on Friday. It is important that we have a phone number where we can reach you. It could be your home, office, hotel, or cell phone. If you give us your cell phone number, make sure the phone is charged and turned on.

A nurse will call you between 8:00 am and 7:00 pm to:

  • Review your instructions
  • Confirm information about your procedure
  • Complete a brief assessment
  • Answer your questions
  • Tell you where you should go

If you do not receive a call by 7:00 pm, please call (212) 639-6689.

The second call will be from the Admissions Center to tell you when to arrive. This call will be between 3:00 pm and 7:00 pm. If you do not receive this call by 7:00 pm, please call (212) 639-7881.

On the day of the procedure, please be aware that many things can impact the start time of your procedure. The procedure before yours may last longer than expected. An emergency may need to be done in the room you are scheduled for. If there is a delay in your start time, we will let you know.

The Day of Your Procedure

The morning of your procedure:

  • You may shower, but do not apply any cream or lotion.
  • Take your medications with water. Do not take any medicine listed on the aspirin card or that your doctor has told you not to take.
  • If you use contact lenses, wear glasses instead. If you do not have glasses, bring a container for your contact lenses.
  • If you are being admitted to the hospital:
    • Bring your medications with you.
    • Leave valuables and jewelry, including rings, at home.
    • Bring only the money you need, e.g., for a newspaper.
    • Bring your MSKCC outpatient identification card.
    • Go to the Admissions Center on the ground floor lobby of 1275 York Avenue.

In Interventional Radiology

You will be brought to Interventional Radiology 30 to 45 minutes before your procedure. If you don't already have one, an intravenous (IV) line will be placed in a vein. You may be given an antibiotic through the IV line.

You will also meet the doctor who will place the catheter. He or she will explain the procedure and ask you to sign a consent form. You will be brought into the procedure room. The doctor will use fluoroscopy (real time x-rays) or a computed tomography (CT) scan to aid in placing the catheter. You will receive medication through your IV line to make you feel drowsy. The area where the catheter is inserted will be numbed with an injection of anesthetic.

After the drainage catheter is inserted, a silicone disk is placed on the catheter. (See Figure 1.) The purpose of this disk is to allow the catheter to be secured to the skin. There are times when the catheter may be secured with a suture, in addition to the disk. This disk is held to the skin with an adhesive dressing. A black mark is placed immediately above the disk on the catheter. This mark lets you see if the catheter has changed position.

Your Catheter

The external end of the catheter will be attached to a three-way stop-cock (see Figure 2). It is called a three-way stopcock because it has 3 points of attachment and a tap that can be turned to control the flow. The drainage bag will be connected on the opposite side of the catheter. The final attachment point has a protective cover on it, called a Clave®. You will recognize the Clave® because it is blue.

The drainage bag can be attached to your clothes with a safety pin or secured to your leg with Velcro straps. The bottom of the bag has a blue twist cap, which you will use to drain the bag.

After Your Procedure

After the procedure is complete, you will return to your in-patient room or to the Pre-Surgical Center. You will need to stay in bed until the sedation has worn off. If you need help or want to go to the bathroom, use your call bell. Someone will come in to assist you.

Caring for Your Drainage Catheter

You will be taught how to:

  • Inspect the catheter
  • Flush the catheter with normal saline
  • Empty drainage from the bag
  • Record the amount of drainage

Once a week, your dressing, stopcock, and drainage bag will need to be changed. You will need to change the dressing more frequently if it becomes loose, wet, or soiled. If a wet dressing is left against your skin, it may cause your skin to become reddened, sore, and irritated.

You may need help to change the dressing and drainage equipment. You will be able to inspect the catheter and instill the sterile normal saline yourself.

Inspecting Your Catheter

You must inspect your catheter every day. A hand held mirror can be useful for this.

  1. Find the black mark to assure it is in the correct position. (See Figure 1.) Your nurse will show you where it should be.
  2. Check the dressing to assure that it is secure. If the dressing is wet, soiled, has come loose, or started to lift from the skin, it needs to be changed.
  3. Examine the skin around the catheter to see that it is in good condition. There should be no redness, areas of broken skin, or rash. Fluid should not leak around the catheter.
  4. Look at the fluid in the bag. It should be flowing freely into the bag. There should be no change in the way it looks.
  5. Inspect the catheter and the drainage bag for kinks in the tubing.

If you detect a problem, finish your catheter care. Then call the nurse or fellow. The contact information is at the end of this booklet.

Instilling Sterile Normal Saline into the Drainage Catheter

You will need to flush your catheter with 10 mL (cc) of normal saline twice a day. To do this you will need:

  • A 10 mL (cc)  pre-filled normal saline syringe
  • 2 alcohol wipes
  1. Wash and dry your hands before you begin. You can use soap and water or an alcohol hand cleanser.
  2. Remove the cap from the syringe with a twisting motion. Lay the syringe on the table. Do not allow the tip of the syringe to touch anything.
  3. Sit or lie comfortably. The “off” tap of the stopcock should be facing the blue Clave®. Turn it in the direction of the drainage bag. (See Figure 2.)
  4. Wipe the blue Clave® thoroughly with an alcohol wipe. Insert the syringe onto the Clave® using a twisting motion. Push the plunger of the syringe to instill 10 mL of normal saline into the catheter. Instill the saline in short bursts of 2 to 3 mL of fluid at a time. Never pull back on the plunger after pushing the saline through the catheter.
  5. If you have pain, feel resistance, or see leakage around the catheter, stop the instillation. Call the nurse or fellow at the numbers listed at the end of this booklet.
  6. Remove the syringe with a twisting motion. Discard it in your household garbage.
  7. Turn the “off” tap of the stopcock back in the direction of the Clave®. (See Figure 2.)
  8. You should see fluid drain into the bag.

Emptying collected drainage from the bag

You will need to measure and empty the drainage twice a day or more often if necessary. Use the container you were given in the hospital.

To do this you will need:

  • A measuring container
  • Gloves
  • Alcohol swabs
  1. Wash and dry your hands before you begin.
  2. Put on non-sterile gloves.
  3. Unscrew the blue twist cap on the drainage bag while holding it over measuring container.
  4. Allow fluid to drain into the container.
  5. When all fluid has drained out of the bag, twist the blue cap closed.
  6. Wipe the cap with an alcohol swab.
  7. Measure the amount of fluid in the container. You may flush the fluid in the toilet.
  8. Wash the measuring container with soap and water. Allow it to air dry.
  9. Discard your gloves and clean your hands with soap and water or an alcohol hand cleanser.
  10. Record the amount of drainage on the form at the end of this booklet.

Changing the Uresil® dressing

The Uresil® dressing system keeps the catheter in place by holding the silicone disk to the skin. The disk is secured to the drainage catheter. The dressing covers the disk, which keeps the catheter in place.

The dressing, stopcock, and drainage system will need to be changed once a week. The dressing may need to be changed more often if it gets wet, soiled, pulls away from the skin, or loosens. Although you may need the assistance of your trained helper to do the dressing and equipment changes, you can assemble the equipment yourself. Begin by washing your hands. Then gather the following equipment to change the dressing, the stopcock, and the drainage system:

Dressing

  • 1 Uresil® adhesive dressing
  • 3M® No Sting Barrier Film
  • Adhesive remover wipe
  • 1 alcohol wipe
  • Plain gauze
  • Mild soap and a cup of water
  • Non-sterile gloves
  • Optional: Telfa®
  • Waste container

Stopcock and Drainage Equipment

  • Non-sterile gloves
  • 1 Clave®
  • 1 sterile three-way stopcock
  • 1 drainage bag
  • 1 UC Strip® catheter tube fastener
  • 1-inch Micropore® paper tape
  • Scissors to cut the tape

Sit or lie comfortably. At this point, you might need your trained helper to continue. The person doing the dressing change should:

1. Wash your hands and put on non-sterile gloves.

  1. Remove the old dressing. Hold the silicone disk in place using one finger to prevent tension or pulling on the catheter. Locate the slit in the Uresil® dressing. From this spot, slowly and gently peel the adhesive away from the skin while holding the disk. If your skin is sensitive, ask your helper to rub adhesive remover along the dressing edge. It may minimize the discomfort.
  2. Loosen and remove the UC Strip®  fastener. Put the drainage bag in a place where it will not fall.
  3. Dispose of the old dressing.
  4. Use a gauze pad moistened with soap and water to clean the skin around and under the disk. Then clean the top and bottom sides of the silicone disk itself. Always hold one side of the disk firmly on the skin while cleaning under the other side.
  5. Rinse and dry the skin and the silicone disk with fresh gauze and water.
  6. Wipe the top side of the silicone disk with an alcohol wipe. This removes any soap residue.
  7. Check the drainage catheter. The black ink mark should be just above the silicone disk.
  8. Inspect the insertion site under the silicone disk. Always hold one side of the disk firmly on the skin while tilting up the other side. Call the nurse or fellow if you see any:
  • Redness
  • Swelling
  • Leakage of fluid around the catheter
  1. You may notice new tissue growing around the insertion site. This is harmless, but it can be removed by your doctor if it is painful.
  2. Apply the 3M® No Sting Barrier Film to the skin around and under the silicone disk. Then apply more to the top of the disk where the dressing will be placed. This protects your skin and helps the adhesive stick better.
  3. Cut a slit in a 2 inch by 2 inch piece of Telfa®. Slide it under the disk, around the catheter. This will prevent moisture build up under the disk. (See Figure 3.)
  4. Open the slit and place the Uresil® dressing around the catheter (see Figure 4). Place the dressing over the flat part of the disk, but under the disk's nipple. If possible, the slit in the dressing should point towards the patient's feet.
  5. The Uresil® dressing has 3 pieces of backing. Start at one of the lower corners of the largest piece and slowly peel the backing paper away. As you peel away the paper, press the adhesive to the skin. This step will require practice and you will do it while you are in the hospital. If the dressing does not adhere properly, remove the Uresil® dressing and Telfa® and restart at step 10.
  6. Remove the other 2 pieces of backing paper one at a time. Press the adhesive to the skin. Overlap the slit edges of the dressing to make the dressing more secure.
  7. Remove your gloves and discard them in the waste container. Wash your hands.
  8. If you will not be changing your drainage bag at this time, proceed to step 10 below.

Changing the Stopcock and Drainage Equipment

  1. Wash your hands.
  2. Open the packages containing the Clave®, three-way stopcock, and drainage bag. Save the package from the drainage bag.
  3. Attach the Clave® to center port of the stopcock (see Figure 2).
  4. Connect the tubing from the drainage bag to the stopcock with a twisting motion. Close the blue drainage port on the bottom of the bag by turning it clockwise. Closing the port prevents leaking.
  5. Place the assembled drainage bag back in its packaging. This will keep it clean until you are ready to connect it to the catheter.
  6. Put on non-sterile gloves.
  7. Loosen and remove the old UC Strip® fastener if you have not already done this.
  8. Twist off the old stopcock and drainage system from the catheter and discard. Quickly attach the new stopcock and drainage system.
  9. Make sure the off tap of the stopcock is turned in the direction of the Clave®.
  10. Secure the new tubing to the skin with a UC Strip®.
  1. Remove the backing from the center of the UC strip® to expose the adhesive. (Figure 5)
  2. Place the center section of the adhesive onto the drainage bag tubing about 2 to 4 inches down from stopcock (Figure 6). Press the adhesive around the tubing. The remaining adhesive will stick together.
  3. Select a position for the UC Strip®. The UC Strip® and drainage bag tubing should be lower than the catheter insertion site. Rest the tubing on the skin on the selected site. There should be no pull or tension on the catheter. There should be a gentle bowing of the catheter.
  4. Remove the backing paper from each side of the UC Strip®, one at a time. Smooth the adhesive onto the skin (Figure 7). The UC Strip® will prevent pulling, tension, or kinking of the drainage catheter and tubing.
  1. Secure the drainage bag with the belt or with a safety pin. You can attach the bag to the waistband of your clothing with the safety pin or to your leg with the included Velcro straps. The bag should be below the level of the catheter. That allows the catheter to drain by gravity.
  2. Check to see that the catheter is draining into the new tubing.
  3. When you have finished, remove the latex gloves and clean your hands.

Signs and Symptoms of Blockage

There are a number of things that may mean the drainage catheter is blocked. They include the following:

  • There is a decreased amount or no drainage.
  • There is constant leakage around the insertion site.
  • The catheter cannot be flushed or it leaks when it is flushed.
  • You have fever and chills.

If any of these signs or symptoms appear, whether alone or together, check the catheter first.

  • The black ink mark should be located slightly above the nipple of the silicone disk. If it is not, the catheter may have moved.
  • If the black mark has not moved, check the position of the tap on the three-way stopcock. Make sure it is pointing in the direction of the Clave®.
  • Remove any kinks in the tubing since they can stop the flow into the drainage bag.
  • If there is still no drainage, flush the catheter with 10 mL (cc) of normal saline. Stop the flush if you have pain, feel resistance, or notice leakage around the catheter.

After doing these checks, call the nurse or fellow at the numbers listed at the end of this booklet.

If you have a fever of 100.4º F (38º C) or higher and you have no other symptoms of blockage, call your primary doctor at MSKCC. You may need to be seen.

Call the nurse or fellow in Interventional Radiology if:

  • The location of the black dot has changed.
  • Your skin looks red, irritated, or different from the way it normally looks.
  • Drainage fluid is leaking around the catheter.
  • There is no longer drainage from the catheter.
  • There is a kink in the tube that you cannot straighten out, causing a blockage in the flow.
  • You have pain, tenderness, or swelling at the catheter site.
  • You have a fever.
  • You feel pain, have resistance, or notice leakage around catheter during flushing.
  • The drainage looks bloody.
  • You have any concerns about your catheter.

Special Points to Remember

The catheter can usually be covered by clothing. You may go to work and exercise with the catheter in place. Avoid movements that involve aggressive stretching from side to side or continual bending. These could dislodge the catheter. You may not swim with your catheter. Speak to the doctor in Interventional Radiology if you have a warm weather vacation planned so that you can be taught what to do in this situation.

You may take showers. Remove the belt and empty the drainage bag. Tape the drainage bag to your body in the location of the catheter. Tape plastic wrap or a gallon sized bag over the dressing to keep it dry. If the dressing gets wet, you will need to change it. Wet dressings are the major cause of skin problems. A hand held shower can help direct the water away from the dressing.

Keep the tubing secured to your body with a UC strip® at all times. When you are getting dressed, take care not to tug on the catheter. Do not allow the tubing to become kinked by clothing such as pantyhose or a belt. Try not to lie on your catheter when you sleep. This will prevent kinking of the catheter.

A Visiting Nurse Service referral will be made for you before you leave the hospital. This nurse will assist you and your helper until you can manage the catheter care on your own.

Conclusion

If you have questions about caring for the catheter, please call Interventional Radiology and ask to speak to a nurse. We will do everything we can to help you.

Ordering Information

Your nurse will give you enough supplies when you go home to last for 2 weeks. In most cases, the Visiting Nurse Service will order supplies after that. If you need to order supplies yourself, you can order them from General Stores at the hospital. You can also order from the company. You will need a prescription to obtain pre-filled normal saline syringes. If your local pharmacy cannot supply the syringes, you can get these from the outpatient pharmacy at MSKCC.

Interventional Radiology Contact Information

For any issue about with your catheter, please contact Interventional Radiology. Monday through Friday, 9:00 am to 5:00 pm, call (212) 639-2236 and ask for the nurse. After hours and on the weekends, call the paging operator, (212) 639-2000 and ask for the Interventional Radiology Fellow on call.