About Your Sutured Drainage Catheter

This information will help you prepare to have your sutured drainage catheter placed at Memorial Sloan Kettering (MSK) and teach you how to care for it when you are at home.

About Your Sutured 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. If the fluid is not infected, you may or may not have symptoms.

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 suture (stitch). Fluid will drain from the catheter into a small bag. Your catheter will be removed when the fluid and infection are gone.

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Having Your Drainage Catheter Inserted

Your drainage catheter will be inserted by an interventional radiologist. An interventional radiologist is a doctor who specializes in image-guided procedures.

The procedure usually takes less than 1 hour. Your interventional radiologist will explain the procedure to you and give you time to ask any questions before you sign a consent form.

After the procedure, your catheter will be attached to a bag to collect the drainage. Your doctor will give you an idea of how much drainage you should expect.

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, follow the guidelines below.

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Before Your Procedure

Ask about your medications

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 taking. 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:

apixaban
(Eliquis®)
dalteparin
(Fragmin®)
meloxicam
(Mobic®)
ticagrelor
(Brilinta®)
aspirin
 
 
dipyridamole
(Persantine®)
 
nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen
(Advil®) or naproxen (Aleve®)
tinzaparin
(Innohep®)
 
celecoxib
(Celebrex®)
edoxaban
(Savaysa®)
pentoxifylline
(Trental®)
warfarin
(Coumadin®)
cilostazol
(Pletal®)
enoxaparin
(Lovenox®)
prasugrel
(Effient®)
 
clopidogrel
(Plavix®)
Fondaparinux
(Arixtra®)
rivaroxaban
(Xarelto®)
 
dabigatran
(Pradaxa®)
heparin
(subcutaneous shot)
sulfasalazine
(Azulfidine®, Sulfazine®)
 

Your doctor may or may not tell you to stop taking the medication, depending on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.

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.

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.

If you take any diuretics (medications that make you urinate more often), you may need to stop taking them the day of your procedure. Some examples are furosemide (Lasix®) or hydrochlorothiazide. Speak with your doctor.

Arrange for someone to take you home

Most people will stay in the hospital overnight. However, if you are being discharged after your procedure, you must have someone 18 years or older take you home. If you don’t have someone to do this, 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.

In New York:

     Partners in Care: 888-735-8913

     Prime Care: 212-944-0244

In New York or New Jersey:

     Caring People: 877-227-4649

Tell us if you’re sick

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.

Note the time of your appointment

A staff member from Interventional Radiology will call you 2 business days before your procedure. They will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Thursday before. If you don’t receive a call by 12:00 pm on 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.

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The Day of Your Procedure

Between midnight and up until 2 hours before your scheduled arrival time, you can drink a total of 12 ounces of clear liquids (see Figure 1). This includes the liquids you will need to swallow any medications you were instructed to take the morning of your procedure. Examples of clear liquids include:

Figure 1. 12 ounces of a clear liquid
  • Water
  • Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
  • Gelatin, such as Jell-O®
  • Clear fruit juices with no pulp, such as cranberry, grape, or apple
  • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
  • Coffee or tea, without milk or cream

Things to remember

  • Take your medications the morning of your procedure as instructed by your doctor. 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.

What to bring with you

  • 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 CPap or BiPAP 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.

Where to go

  • Memorial Hospital
    1275 York Avenue (between East 67th and East 68th Streets), New York, NY 10065

    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.

    When you arrive at Memorial Hospital, take the M elevator to the 2nd floor. Enter through the glass doors and check in at the desk.

  • Memorial Sloan Kettering Westchester
    500 Westchester Avenue, West Harrison, NY 10604

    When you enter the building, check in at the reception desk and they will direct you to Interventional Radiology

 

What to expect

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.

You will be brought into the procedure room. If you don’t have an intravenous (IV) line, your nurse will put one in. You will receive medication through your IV to make you feel drowsy.

The area where the catheter is inserted will be numbed with an injection of anesthetic. Your doctor will use fluoroscopy (real time x-rays), a computed tomography (CT) scan, or ultrasound to help place the catheter.

After your drainage catheter is inserted, it will be sutured  (stitched) to your skin at the point where it exits your body. You will be able to see the thread around your catheter.

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After Your Procedure

After your procedure, you will be brought to the recovery room. You will need to stay in bed until the sedation has worn off. You will then return to your hospital room or go home with your caregiver. 

About your catheter

Figure 2.

You will have a black mark on the catheter above the suture (see Figure 2). Your nurse will show it to you. This mark should always be the same distance from your skin. If it changes, this means that the catheter has moved. You must call Interventional Radiology so someone there can check it.

The external end of the catheter will be attached to a 3-way stopcock (see Figure 3). It is called a 3-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 to the attachment point opposite to the catheter. The third attachment point has a protective cover on it, through which you can inject fluids. The cover is called a needleless connector (MicroClave®). You will have a dressing over your catheter.

Figure 3.

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.

Showering

You may take showers but you will need to keep your dressing dry. A hand-held shower can help direct the water away from the dressing. You will also need to cover your dressing. If the dressing gets wet, you will need to change it. Wet dressings are a common cause of skin problems.

Before you shower, remove the belt and empty the drainage bag. Tape the drainage bag to your body near the catheter or use a strap to attach it to your waist. Tape plastic wrap or a gallon sized bag over the dressing to keep it dry.

You can also use AquaGuard, which is a one-time use waterproof cover to protect your dressing. When you shower, make sure that that your catheter is covered to prevent it from getting wet.

Applying the AquaGuard

  1. The edges of the AquaGuard have peelable tape. Fold over a corner of each side of the tape (see Figure 4).

     

    Figure 4.
  2. Hold the AquaGuard with the arrows pointing towards your head. Peel off the top strip and place the top edge of the AquaGuard above the dressing. Smooth it down.
  3. Then grab a folded corner and peel down one side, smoothing as you go.
  4. Do the bottom and remaining side the same way.

Don’t let the tape on the AquaGuard touch the dressing. It can lift your dressing when you remove the AquaGuard after showering.

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Caring for Your Sutured Drainage Catheter

Your nurse will teach you how to care for the catheter. Use this resource 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 your catheter.
  • Flush your catheter with normal saline.
  • Record the amount of drainage in the bag.
  • Empty drainage from the bag.

Your dressing and 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 irritated and sore.

You may need someone to help you change the dressing and drainage equipment. You will be able to inspect the catheter and flush it with the normal saline yourself.

Inspecting your catheter

You must inspect your catheter every day. You can use a hand-held mirror to do this.

  1. Find the black mark to make sure it is in the correct position.
  2. Check the dressing to make sure it is secure. If the dressing is wet, soiled, has come loose, or started to lift from your skin, it needs to be changed.
  3. Examine your skin around the catheter when you are changing the dressing 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 see a problem, finish your catheter care. Then call the nurse or fellow. The contact information is at the end of this resource.

Flushing your sutured drainage catheter

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 of normal saline.

Below is a video that shows how to flush a biliary catheter. Follow the same directions to flush your sutured drainage catheter.

Steps

  1. Gather your supplies. You will need:
    • 1 (10 mL) prefilled normal saline syringe
    • 2 alcohol wipes
  2. Wash your hands thoroughly with warm water and soap or use an alcohol based hand sanitizer.
  3. 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.
  4. Sit or lie comfortably. Turn the stopcock toward the drainage bag (see Figure 3).
  5. Clean the needleless connector on the stopcock with an alcohol wipe for 15 to 30 seconds, rubbing vigorously.
  6. Place the syringe onto the needleless connector. Hold the connector while you push and turn the syringe clockwise (to the right) to lock it into position.
  7. 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
  8. When the syringe is empty, turn it counterclockwise (to the left) to remove it. You can throw it away in your regular trash. Turn the stopcock back to the direction of the needleless connector. You will probably see fluid drain into the bag.

Emptying the collected drainage from the bag

You will need to measure and empty the drainage twice a day or more often if necessary. 

  1. Gather your supplies. You will need:
    • The measuring container you received in the hospital
    • Non-sterile gloves
    • 2 alcohol wipes
  2. Wash your hands thoroughly with warm water and soap or use an alcohol based hand sanitizer.
  3. Put on the non-sterile gloves.
  4. Clean the cap at the bottom of the drainage bag with an alcohol wipe. 
  5. Twist the cap open while holding it over the measuring container.
  6. Allow the fluid to drain into the container. Do not let the bottom of the bag touch the sides of the drainage container. 
  7. When all fluid has drained out of the bag, twist the cap closed.
  8. Clean the cap with an alcohol wipe.
  9. Measure the amount of fluid in the container, then flush the fluid down the toilet.
  10. Wash the measuring container with soap and water. Allow it to air dry.
  11. Throw out your gloves and clean your hands with soap and water or an alcohol-based hand sanitizer.
  12. Record the amount of drainage on the form at the end of this resource. Be sure to subtract the amount of your saline flush (3 mL, 5mL, or 10 mL) from the daily totals.

Changing the 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. 

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

  1. Gather your supplies:
    • 1 Microfoam dressing
    • 3MTM No Sting Barrier Film
    • Adhesive remover wipe
    • Alcohol wipes
    • Gauze
    • Mild soap and a cup of water
    • Non-sterile gloves
    • 1 (2 inch x 2 inch) Telfa®
    • Scissors 
    • UC Strip® fastener
    • Waste basket
  2. Wash your hands with warm water and soap or use an alcohol based hand sanitizer. 
  3. Clean your scissors with an alcohol wipe. If your Telfa is larger 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 (see Figure 5).
  4. Cut a one-inch section from the top of the Microfoam (see Figure 6). Cut the same slit in the Microfoam as you did in the Telfa.

     

    Figure 5.
             
    Figure 6.
  5. 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.
  6. Wash their hands and put on non-sterile gloves.
  7. 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 caregiver to rub adhesive remover along the dressing edge. It may minimize the discomfort.
  8. Loosen and remove the UC strip catheter fastener. Put the drainage bag in a place where it will not fall.
  9. Throw out the old dressing.
  10. Use a gauze pad moistened with soap and water to clean the skin around the catheter.
  11. Rinse and dry the skin with fresh gauze and water.
  12. Check the drainage catheter. The black ink mark should be just above the stitch (see Figure 1).
  13. Inspect the insertion site. Call your nurse or fellow if you see any:
    • Redness
    • Swelling
    • Leakage of fluid around the catheter
  14. Apply the 3M No Sting Barrier Film to the skin. This protects your skin and helps the adhesive stick better.
  15. Slide the Telfa around the catheter.
  16. Center the Microfoam 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 your skin. The 2 pieces of Microfoam made by the slit should overlap each other by a one-quarter of an inch. This will keep the dressing close to the catheter (see Figure 7).
    Figure 7.
             
    Figure 8.
  17. Put the one-inch strip of Microfoam across the overlap (see Figure 8). Putting on the Microfoam takes practice. If the dressing does not stick well, take it off and start again with fresh Microfoam.
  18. Remove your gloves and throw them out. Wash your hands.
  19. If you will not be changing your drainage bag at this time, proceed to step 12 below.

Changing the stopcock and drainage equipment

Below is a video that shows how to change the equipment on a biliary catheter. Follow the same directions to change the equipment on your sutured drainage catheter.

  1. Gather your equipment:
    • Non-sterile gloves
    • 1 needleless connector
    • 1 sterile 3-way stopcock
    • 1 drainage bag
    • 1 UC Strip fastener
    • Safety pin or strap
    • Gauze
    • 1-inch Micropore® paper tape
    • Waste basket
  2. Wash your hands thoroughly with warm water and soap or use an alcohol based hand sanitizer.
  3. Open the packages containing the needleless connector, 3-way stopcock, and drainage bag. Put the package from the drainage bag to one side.
  4. Remove the protective cover from the base of the needleless connector and throw it away. Attach the needleless connector to the center port of the stopcock (see Figure 1). Put the stopcock down.
  5. Remove the drainage bag from the package. 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 package. This will keep it clean until you are ready to connect it to the catheter.
  7. Wash your hands again, then put on non-sterile gloves.
  8. If you have not done so, loosen and remove the old UC Strip fastener.
  9. If the bag is attached with a safety pin, remove the safety pin. Make sure the new drainage bag is within your reach.
  10. While holding gauze under the connector, twist off the old stopcock and drainage system from the catheter and throw it away. Quickly attach the new stopcock and drainage system.
  11. Make sure the off tap of the stopcock is turned in the direction of the needleless connector.
  12. Now you will secure the new tubing to the skin with a UC Strip fastener. Peel off the backing from the center section of the UC Strip fastener to expose the adhesive (see Figure 9).
    Figure 9.
  13. Place the center section of the adhesive onto the drainage bag tubing about 2 to 4 inches down from stopcock. Make sure the fastener is not on the catheter itself. Press the adhesive around the drainage bag tubing (see Figure 10). The remaining adhesive will stick together.
    Figure 10.
  14. Select a position for the UC Strip fastener. The UC Strip fastener and drainage bag tubing should be lower than the catheter insertion site in order for it to drain. Rest the tubing on the skin on the selected site. There should be no pull or tension on the catheter. You should see a gentle bowing of the catheter.
  15. Remove the backing paper from each side of the UC Strip fastener, one at a time. Smooth the adhesive onto the skin. The UC Strip fastener will prevent pulling, tension, or kinking of the drainage catheter and tubing (see Figure 11).
    Figure 11.
  16. 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. 
  17. Check to see that the fluid is draining into the new tubing.
  18. When you have finished, remove your gloves and wash your hands.
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Activities While You Have Your Sutured Drainage Catheter

  • You can go to work and exercise with your catheter in place. Avoid movements that involve stretching from side to side or continual bending. These could dislodge the catheter.
  • Do not swim, take a bath, or submerge your catheter in water. Speak with your doctor in Interventional Radiology if you have a vacation planned so that we can teach you what to do in this situation.
  • The suture that holds the catheter in place can become uncomfortable. Generally, this happens when the suture is pulled away from the skin. To prevent or minimize this, make sure the catheter is not pulled when attaching the catheter fastener. Keep the tubing secured to your body with a catheter fastener at all times.
  • When you are getting dressed, be sure 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. Clothing can usually cover the catheter.
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Call Your Nurse or Doctor in Interventional Radiology if:

  • There is no drainage from your catheter or if the amount of drainage is much less than usual. 
  • The drainage looks bloody.
  • There is leakage around the insertion site.
  • You cannot flush the catheter or it leaks when it is flushed.
  • The location of the black mark has changed.
  • There is no longer drainage from the catheter when the 3-way stopcock is in the upright position
  • The clamp has broken or opened.
  • There is a kink in the tube that you cannot straighten out, causing a blockage.
  • You have pain, tenderness, or swelling at the catheter site.
  • Your skin around the catheter looks red, irritated, or different from the way it normally looks.
  • You have a temperature of 100.4º F (38º C) or higher and other symptoms of blockage such as pain or leakage from your catheter.
  • You have any concerns about your catheter.
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Call Your Primary Doctor or Nurse at MSK if You:

  • Have a temperature of 100.4º F (38º C) or higher and you have no other symptoms of blockage.
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Contact Information

If you have any questions or concerns, please call Interventional Radiology at 212-639-2236. You can reach a staff member Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the fellow on call for Interventional Radiology.

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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 your supplies after that.

If you want to order supplies yourself, call Interventional Radiology at 212-639-2236 to place your order using the supply order numbers below. You can pick up your order 2 business days later at  the IR Clinic, located at 16 East 60th Streets, between Fifth and Madison Avenues

You will need a prescription for prefilled normal saline syringes. You can get the prescription from the IR clinic. If your local pharmacy does not have the syringes, you can get them from the outpatient pharmacy at Memorial Hospital at 1275 York Avenue, between East 67th and East 68th Streets. It is open Monday through Friday from 9:00 am to 5:45 pm. To reach the pharmacy, call 212-639-8464.

Supply order numbers

Item
Supply Number
Adhesive Remover (1 box)
3170
Alcohol Wipes (1 box)
3330
Microfoam (1 box)
3316
Micropore paper tape (1 box)
3174
Non-sterile gloves (1 box)
4545
Plain gauze (1 package)
3424
Skin Prep (1 box)
3332
Telfa (1 each)
3327
UC Strip catheter fastener ( 1 box)
2676
Drainage bag (1 each)
3361
 
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Drainage Record

Date

Morning output

Afternoon output

Total (subtract flush amount)

Notes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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