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A Sutured Drainage Catheter

This information will help you prepare for having your sutured drainage catheter placed and care for it when you are 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 stitch. 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.

Before Your Procedure

If you are already in the hospital your nurse will help you prepare. In some cases you will be scheduled to come into the hospital for the procedure. If this is the case, please follow these guidelines:

  • You may have to stop certain medications before your procedure. The card Common Medicines Containing Aspirin and Nonsteroidal Anti-Inflammatory Products contains a list of medications that you must stop taking before your procedure
  • Ask your doctor what to do if you take blood thinners such as:
    • Warfarin (Coumadin®)
    • Clopidogrel (Plavix®)
    • Cilostazol (Pletal®)
    • Dalteparin (Fragmin®)
    • Enoxaparin (Lovenox®)
    • Heparin injected under the skin (subcutaneously)
    • Prasugrel (Effient®)
    • Ticlopidine (Ticlid®)
    • Dabigatran (Pradaxa®)
    • Aspirin
      • If your doctor asks you to stop taking aspirin for the procedure, stop taking it 5 days before your procedure. If you have any questions, call Interventional Radiology. The number is (212) 639-2236. Ask to speak with the nurse.
    • Ask your doctor what to do if you take medicine for diabetes such as insulin, glucophage (Metformin®), or glipizide (Glucotrol®).
    • Vitamin E and nonsteroidal anti-inflammatory medicines (NSAIDs) can also increase your risk of bleeding. You will need to stop taking medicines that contain vitamin E 10 days before your procedure. You will need to stop taking NSAIDS 2 days before your procedure. Examples of NSAIDs are ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
  • If you had a stroke or a heart attack, you may need to have another doctor's visit for medical clearance. This will be an important safety step for you.
  • Call your doctor if you develop any illness before your procedure. This includes a fever, cold, flu, or a sore throat.
  • Do not eat any solid food after midnight the night before the procedure.
  • Drink only clear liquids the day of your procedure.
    • Stop drinking liquids 2 hours before you are scheduled to arrive at the hospital for your procedure.
  • If you have any questions about the procedure, you may call an interventional radiology nurse between 9:00 am and 5:00 pm. The phone number is (212) 639-2236.

Pre-Procedure Telephone Call

The Admissions Center will call you the business day before your procedure. It is important that we have a phone number where we can reach you. If you give us your cell phone number, make sure the phone is charged and turned on. You will be told when to arrive for the procedure. We try to call between 3:00 pm and 7:00 pm. If you do not receive the call by 7:00 pm, please call (212) 639-7881.

If you have any questions about the procedure, you may call an interventional radiology nurse between 9:00 am and 5:00 pm. The phone number is (212) 639-2236.

The Day of Your Procedure

  • 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.
  • You may shower, but do not apply any cream or lotion.
  • Follow your doctor's instructions regarding which medicines to take the day of your procedure. Take them with water or another clear liquid.
    • Do not take medicines that thin the blood unless your doctor told you to.
    • Do not take diuretics (medicines that make you urinate) such as furosemide (Lasix®) or hydrochlorothiazide (HCTZ).
  • Bring:
    • Your medicines with you on the day of the procedure
    • Only the money you need (e.g., for a newspaper or parking costs)
  • If you use contact lenses, wear glasses instead. If you do not have glasses, bring a container for your contact lenses.
  • Leave valuables and jewelry, including rings, at home.

Please arrive on time. Enter the hospital through the main entrance at 1275 York Avenue. Take the M elevators at the top of the escalator to the 2nd floor. As you step off the elevator, enter the double doors to the Pre-Surgical Center. Check in at the desk. Please arrive on time.

In the Pre-Surgical Center (PSC), you will change into a gown, robe, and slippers. An intravenous (IV) line will be started. When you are ready, you will be escorted to Interventional Radiology.

In Interventional Radiology

After you are positioned on the table, you will get medicine through your IV to help you relax. The doctor will use fluoroscopy (real time x-rays), computed tomography (CT) scan, or ultrasound to aid in placing the catheter. The area where the catheter is inserted will be numbed with an injection of anesthetic.

After the drainage catheter is inserted, the catheter is stitched to your skin at the point where it exits your body. You will be able to see the thread around your catheter. A black mark is placed on the catheter above the stitch. (See Figure 1.) Your nurse will show it to you. This mark should always be same distance from your skin. If it changes, you know the catheter has moved. You must call Interventional Radiology so they can check it.

After the procedure

After the procedure, you will recover in a recovery room. You will need to stay in bed until the sedation has worn off.

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 opposite to the catheter. The final attachment point has a protective cover on it, through which you can inject liquids. The cover is called a Clave®.

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 twist cap, which you will use to drain the bag.

Caring for Your Drainage Catheter

Your nurse will teach you how to care for the catheter. Use this booklet at home to remind you of what you learned. At first, a visiting nurse will come to your home to help you care for the catheter. It won't be long before you feel confident doing it yourself.

Every day you will:

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

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

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).
  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 when you are changing the dressing to see that it is in good condition. The dressing is changed once a week. 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 Clave®. Turn it in the direction of the drainage bag. (See Figure 2.)
  4. Wipe the Clave® thoroughly with an alcohol wipe. Insert the syringe onto the Clave® using a twisting motion. Push the plunger of the syringe to instill 10mL 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. Twist the cap at the bottom of the drainage bag open while holding it over the measuring container.
  4. Allow fluid to drain into the container.
  5. When all fluid has drained out of the bag, twist the 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 dressing

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 Microfoam dressing
  • 3MTM No Sting Barrier Film
  • Adhesive remover wipe
  • 1 alcohol wipe
  • Plain gauze
  • Mild soap and a cup of water
  • Non-sterile gloves
  • Telfa®
  • Scissors to cut Telfa®
  • Waste container

Stopcock and Drainage Equipment

  • Non-sterile gloves
  • 1 Clave®
  • 1 sterile three-way stopcock
  • 1 drainage bag
  • 1 catheter fastener, such as UC Strip®
  • 1-inch Micropore® paper 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.
  2. Remove the old dressing.
  • Hold the catheter in place to prevent tension or pulling on it.
  • Locate the slit in the Microfoam dressing.
  • From this spot, slowly and gently peel the adhesive away from the skin.
  • If your skin is sensitive, ask your helper to rub adhesive remover along the dressing edge. It may minimize the discomfort.
  1. Loosen and remove the catheter fastener. Put the drainage bag in a place where it will not fall.
  2. Dispose of the old dressing.
  3. Use a gauze pad moistened with soap and water to clean the skin around the catheter.
  4. Rinse and dry the skin with fresh gauze and water.
  5. Check the drainage catheter. The black ink mark should be just above the stitch (see Figure 1).
  6. Inspect the insertion site. 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 3MTM No Sting Barrier Film to the skin. This protects your skin and helps the adhesive stick better.
  3. Cut a slit in the Telfa®. Slide it around the catheter (see Figure 3).
  4. Cut a one-inch section from the top of the Microfoam (see Figure 4). Cut the same slit in the Microfoam as you did in the Telfa®.
  5. Center the dressing over the catheter. The slit should be pointing downward if possible. Peel the covering off the back of the Microfoam. Carefully lay the Microfoam over the Telfa®. Press the edges to the skin. The two pieces of Microfoam made by the slit should overlap each other by a ¼ of an inch. This will keep the dressing close to the catheter (see Figure 5). Put the one-inch strip of Microfoam across the overlap (see Figure 6). Putting on the Microfoam takes practice. If the dressing does not stick well, take it off and start again with fresh Microfoam.

  1. Remove your gloves and discard them in the waste container. Wash your hands.
  2. If you will not be changing your drainage bag at this time, proceed to step 11 below.

Changing the Stopcock and Drainage Equipment

  1. Wash your hands if you have done anything in between changing the dressing and the stopcock and drainage equipment.
  2. Open the packages containing the Clave®, three-way stopcock, and drainage bag. Put the package from the drainage bag to one side.
  3. Remove the narrow cover from the end of the Clave®. Throw it away.
  4. Attach the Clave® to the center port of the stopcock (see Figure 1).
  5. Connect the tubing from the drainage bag to the stopcock with a twisting motion. Close the drainage port on the bottom of the bag by turning it clockwise. Closing the port prevents leaking.
  6. Place the assembled drainage bag back in its packaging. This will keep it clean until you are ready to connect it to the catheter.
  7. Put on non-sterile gloves.
  8. Loosen and remove the old catheter fastener if you have not already done so.
  9. Twist off the old stopcock and drainage system from the catheter and discard. Quickly attach the new stopcock and drainage system.
  10. Make sure the off tap of the stopcock is pointed in the direction of the Clave®.
  11. Secure the new tubing to the skin with a catheter fastener.
  • Remove the backing from the center of the catheter fastener to expose the adhesive (see Figure 7).
  • Place the center section of the adhesive onto the drainage bag tubing about two to four inches down from the stopcock (see Figure 8). Press the adhesive around the tubing. The remaining adhesive will stick together.
  • Select a position for the catheter fastener. The catheter fastener 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.
  • Remove the backing paper from each side of the catheter fastener, one at a time. Smooth the adhesive onto the skin (see Figure 9). The catheter fastener 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 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 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.

  1. The black ink mark should be located above the stitch. If it is not, the catheter may have moved.
  2. 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®.
  3. Remove any kinks in the tubing since they can stop the flow into the drainage bag.
  4. If there is still no drainage, flush the catheter with 10 mL 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 Memorial Sloan Kettering Cancer Center (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

Clothing can usually cover the catheter. 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 radiologist if you have a warm weather vacation planned so that you can be taught what to do in this situation.

The stitch that holds the catheter in place can become uncomfortable. Generally, this happens when the stitch is pulled away from the skin. To prevent or minimize this, when attaching the catheter fastener, make sure the catheter is not pulled. Keep the tubing secured to your body with a catheter fastener 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.

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.

Conclusion

If you have questions about caring for the catheter, please call Interventional Radiology and ask to speak to a nurse. The number is (212) 639-2236. We will do everything we can to help you.

Ordering Information

You can order supplies from General Stores at the hospital. You can also order directly 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 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.