This information will help you prepare for the insertion of your drainage catheter with a Uresil® disk at Memorial Sloan Kettering (MSK) and will help you learn how to care for it at home.
The 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 doctor in Interventional Radiology will insert the drainage catheter through your 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.
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:Back to top
Before Your Procedure
You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop. We have included some common examples below.
If you take medication that affects the way your blood clots, ask the doctor performing your procedure what to do. The doctor’s contact information is listed at the end of this resource. Some examples of these medications are:
|aspirin||tinzapain (Innohep®||prasugrel (Effient®)|
|warfarin (Coumadin®)||enoxaparin (Lovenox®)||dabigatran (Pradaxa®)|
|dalteparin (Fragmin®)||clopidogrel (Plavix®)||ticagrelor (Brilinta®)|
|heparin||cilostazol (Pletal®)||ticlopidine (Ticlid®)|
Whether he or she recommends you stop taking it will depend on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.
- If you take insulin or other medications for diabetes, you may need to change the dose before your procedure. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.
- Please review the information in the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). It includes important information about medications you’ll need to avoid before your procedure and what medications you can take instead.
You must have someone 18 years or older take you home after your procedure. If you don’t have anyone, call one of the agencies below. They will provide someone to accompany you home, however there is usually a charge for this service and you will also need to provide transportation.
Partners in Care 888-735-8913
Prime Care 212-944-0244
Caring People 877-227-4649
If you develop any illness (fever, cold, sore throat, or flu) before your procedure, please call a nurse in Interventional Radiology at 212-639-2236. A nurse is available Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the Interventional Radiology fellow on call.pm the business day before your procedure, please call 212-639-5051.
If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.Back to top
The Day Before Your Procedure
The Day of Your Procedure
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids.
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
- Take only the medications your doctor told you to take the morning of your procedure. Take them with a few sips of water.
- Do not apply cream or petroleum jelly (Vaseline®). You can use deodorant and light moisturizers. Do not wear eye makeup.
- Remove any jewelry, including body piercings.
- Leave all valuables, such as credit cards and jewelry, at home.
- If you wear contact lenses, wear your glasses instead, if possible. If you don’t have glasses, please bring a case for your contacts.
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), medications for chest pain, or both
- A case for your glasses or contacts
- Your Health Care Proxy form, if you have completed one
- If you use a C-Pap or Bi-pap machine to sleep at night, please bring your machine with you, if possible. If you can’t bring your machine with you, we will give you one to use while you are in the hospital.
Parking at MSK is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block toward First Avenue, on the right (north) side of the street. A pedestrian tunnel connects the garage to the hospital. For questions about pricing, call 212-639-2338. There are also nearby commercial garages on East 69th Street between First and Second Avenues and on East 65th Street between First and Second Avenues.
Please arrive at the main building of MSK at 1275 York Avenue between East 67th and East 68th Streets. Take the M elevator to the 2nd floor. Enter through the glass doors and check in at the desk.
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.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.
The external end of the catheter will be attached to a 3-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 needleless connector. 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 your procedure, you will return to the recovery room or your inpatient room. 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.
Your nurse will teach you 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.
Inspect your catheter every day using a hand held mirror, a full length mirror, or both.
- Look at the position of the black mark. Make sure it is near the disk (see Figure 1). Your nurse will show you what to look for before you leave the hospital. If the black mark is not near the disk, call your doctor before you flush the catheter.
- Check the dressing to make sure that it is secure. If the dressing is wet, soiled, has come loose or started to pull away from the skin, it needs to be changed.
- Examine the skin around the catheter. There should be no redness, open areas, or rash. Fluid should not leak around the catheter.
- Look at the fluid in the bag. It should be flowing freely into the bag. It should not have changed color or consistency. Check to make sure that the catheter is not kinked, and make sure the UC Strip fastener is holding the catheter firmly. If you find a problem, call your interventional radiology nurse practitioner or fellow. The phone numbers are listed at the end of this resource.
You will need to flush your catheter with normal saline twice a day. Your doctor will tell you whether to use 3 mL, 5 mL, or 10 mL.
Below is a video demonstration of how to flush your drainage catheter.
- Gather your supplies. You will need:
- 1 (10 mL) prefilled normal saline syringe
- 2 alcohol wipes
- Clean your hands. If you’re washing your hands with soap and water, wet your hands, apply soap, rub them together thoroughly for 15 seconds, then rinse. Dry your hands with a disposable towel, and use that same towel to turn off the faucet. If you’re using an alcohol-based hand sanitizer, be sure to cover your hands with it, rubbing them together until they’re dry.
- Take the syringe out of the wrapper. Remove the cap from the syringe using a twisting motion. With the cap off, remove the air from the syringe by holding the syringe open-side up and pushing the plunger slowly until the normal saline is at the top. If your doctor instructed you to flush with less than 10 mL, squirt the extra saline out before you connect the syringe. Lay the syringe on the table. Do not allow the tip of the syringe to touch anything.
- Sit or lie comfortably. Turn the stopcock toward the drainage bag (see Figure 4).
- Clean the needleless connector on the stopcock with an alcohol wipe for 15 to 30 seconds, rubbing vigorously.
- Place the syringe onto the needleless connector. Hold the connector while you push and turn the syringe clockwise to lock it into position.
- Push the plunger of the syringe to push 1/3 of the normal saline into the catheter, and then pause. Push in another 1/3 of the normal saline, and pause again. Push in the rest of the normal saline into the catheter. Never pull back on the plunger. Always push forward.
If you have any of the following while flushing, do not try to put in any more saline. Stop and call your doctor’s office if you:
- Feel pain
- Feel resistance
- See leaking around the catheter
- When the syringe is empty, turn it counterclockwise to remove it. You can throw it away in your regular trash. Turn the stopcock back to the direction of the needleless connector (see Figure 2). You will probably see fluid drain into 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
- Alcohol swabs
- Wash and dry your hands before you begin.
- Put on non-sterile gloves.
- Unscrew the blue twist cap on the drainage bag while holding it over measuring container.
- Allow fluid to drain into the container.
- When all fluid has drained out of the bag, twist the blue cap closed.
- Wipe the cap with an alcohol swab.
- Measure the amount of fluid in the container. You may flush the fluid in the toilet.
- Wash the measuring container with soap and water. Allow it to air dry.
- Discard your gloves and clean your hands with soap and water or an alcohol hand cleanser.
- Record the amount of drainage on the form at the end of this booklet.
The Uresil dressing system is designed to help keep the catheter from moving out of the bile ducts. The disk is secured to your drainage catheter. The dressing covers the disk, which keeps the catheter in place.
Below is a video demonstrating how to change your Uresil dressing.
The dressing, stopcock, and drainage system will need to be changed once a week. If the dressing gets wet, soiled, loose, or pulls away from your skin, change it. Although you may need the assistance of your helper to do the dressing and equipment changes, you can assemble the equipment yourself. Clean your hands, then gather the following supplies:
- 1 Uresil adhesive dressing
- Skin protectant
- Adhesive remover wipe
- Alcohol wipes
- Plain gauze
- Gauze moistened with soap and water
- Non-sterile gloves
- 1 (2 inch x 2 inch) Telfa
- UC Strip fastener
- Wastebasket, if you choose
- Clean your scissors with an alcohol pad. If your Telfa is later than 2 inches by 2 inches, you will need to cut it to that size. Cut a slit in that piece and set it to the side. Sit or lie comfortably. At this point, you will need someone to help you. The person doing the dressing change should follow the instructions below.
- Clean your hands and put on nonsterile gloves.
- Put the drainage bag in a place where it will not fall.
- Hold the silicone disk in place using 1 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 the skin around the catheter is sensitive, wipe adhesive remover around the edge of the dressing to minimize discomfort.
- Loosen and remove the UC Strip fastener as you pull the tape off.
- Dispose of the old Uresil dressing.
- Use a gauze pad moistened with soap and water to clean the skin around and under the disk. Using the same gauze, 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.
- Rinse and dry the skin and the silicone disk with fresh gauze.
- Wipe the top side of the silicone disk with an alcohol wipe. This removes any soap residue.
- Look at the disk nipple. The black ink mark should be just above the disk nipple (see Figure 1). If it moved, finish changing the dressing, and then call your doctor’s office. 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. If you see any of the following, finish changing the dressing and call your doctor’s office:
- Foul-smelling drainage
- Leakage of fluid
- 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.
- Apply the no sting barrier film to the skin around 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.
- Slide the Telfa under the disk, around the catheter (see Figure 3). The slit should point towards the patient’s feet. The Telfa will prevent moisture from building up under the disk.
- Pick up the Uresil dressing. Open the slit and place it around the catheter (see Figure 4). Line the slit up with the slit in the Telfa. Make sure the dressing is adhesive side down, shiny side up. Place the dressing over the flat part of the disk, but under the disk’s nipple. The slit in the dressing should point towards the patient’s feet.
- The Uresil dressing has 3 pieces of backing. Start at the corner of the biggest piece and slowly peel the backing away. As you peel away the paper, press the adhesive to the skin. This will get easier with practice. If the dressing does not stick properly, remove the Uresil dressing and Telfa and restart at step 13.
- Remove the other 2 pieces of backing paper 1 at a time. Press the adhesive to the skin. Overlap the slit edges of the dressing to make the dressing more secure. If you are only changing the dressing, change the UC Strip fastener at this time. This will make the catheter more secure.
- Remove your gloves and discard them in the wastebasket.
- Write date of dressing change on the Uresil dressing so that you know when to change it again.
- Clean your hands.
Below is a video demonstrating how to change the stopcock and drainage equipment.
- Gather your equipment:
- Nonsterile gloves
- 1 needleless connector
- 1 sterile 3-way stopcock
- 1 drainage bag
- 1 UC Strip fastener
- Safety pin or strap
- Clean your hands.
- Open the packages containing the needleless connector, 3-way stopcock, and drainage bag. Save the package from the drainage bag.
- Clean your hands again.
- Remove the protective cover from the base of the needleless connector. Attach the needleless connector to center port of the stopcock (see Figure 2).
- 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.
- Place the assembled drainage bag back in its package. This will keep it clean until you are ready to connect it to the catheter.
- Put on non-sterile gloves.
- If you have not done so, loosen and remove the old UC Strip fastener.
- If the bag is attached with a safety pin, remove the safety pin. Make sure the new drainage bag is within your reach.
- While holding gauze under the connector, twist off the old stopcock and drainage system from the catheter and discard. Quickly attach the new stopcock and drainage system.
- Make sure the off tap of the stopcock is turned in the direction of the needleless connector.
- Secure the new tubing to the abdomen with a UC Strip fastener:
- Remove the backing from the center of the UC Strip fastener to expose the adhesive (see Figure 5).
- Place the center section of the adhesive onto the drainage bag tubing about 2 to 4 inches down from stopcock.
- Press the adhesive around the drainage bag tubing (see Figure 6). The remaining adhesive will stick together.
- Select a position for the UC Strip fastener. The UC Strip fastener and drainage bag tubing should be lower than the catheter insertion site. Rest the tubing on the abdomen on the selected site. There should be no pull or tension on the catheter. You should see a gentle bowing of the catheter.
- Remove the backing paper from each side of the UC Strip fastener, one at a time. Smooth the adhesive onto the abdomen. The UC Strip fastener will prevent pulling, tension, or kinking of the drainage catheter and tubing (see Figure 7).
- Remove the backing from the center of the UC Strip fastener to expose the adhesive (see Figure 5).
- Secure the drainage bag with the strap 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 attached Velcro straps. The bag should be below the level of the catheter. That allows the catheter to drain by gravity (see Figure 8).
- Check to see that the catheter is draining into the new tubing.
- When you have finished, remove your gloves and clean your hands.
The following signs and symptoms that may mean your drainage catheter is blocked.
- Decreased amount or no drainage
- Constant leakage around the insertion site
- Inability to flush catheter
- Leaking around catheter during flushing
- Temperature higher than 100.4° F (38° C) and/or chills
If you have any of the signs or symptoms above, check your catheter first by doing the following:
- The black ink mark should be located slightly above the nipple of the disk. If it is not, the catheter may have moved out of the bile duct.
- If the black mark has not moved, check the position of the tap on the 3-way stopcock. Make sure it is pointing in the direction of the needleless connector.
- Remove any kinks in the tubing since they can stop the flow into the drainage bag.
- If there is still no drainage, gently flush the catheter with the amount of normal saline you usually use. Stop instillation if you have:
- Leakage around the catheter
If you still have any of the symptoms above after checking your catheter, call the nurse or fellow at the numbers listed at the end of this resource.
If you have a fever of 100.4º F (38º C) and you have no symptoms of blockage, call your primary doctor at MSK.
Contact the nurse or fellow in Interventional Radiology if:
- The location of the black mark has changed
- The clamp around disk is loose or opened
- If the stitch is broken (if your catheter is stitched in place)
- Your skin looks red or irritated
- 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 fever
- You experience pain, resistance, or leakage around catheter when instilling normal saline
- You notice a bloody appearance to your drainage
- 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. Do not swim with your catheter. Speak with the doctor in Interventional Radiology if you have a warm weather vacation planned so that you can learn 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. If you plan to change your dressing right after your shower, you do not have to cover it. If you will be not change your dressing, 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.
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.Back to top
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 MSK.Back to top
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.