IPC (indwelling pleural catheter)

About an IPC

An IPC (indwelling pleural catheter) is a small, flexible tube which we insert into your chest.

We do this to remove fluid from around your lungs and help with your breathlessness. 

Procedure overview

To carry out this procedure, we insert the IPC into the pleural cavity in your chest. The pleural cavity (sometimes called the pleural space) is made up of two thin layers (membranes). One of these layers lines your lung and the other lines your chest wall.

One end of the IPC stays inside your chest and the other passes out through your skin. Your skin heals around the entry site, to keep it secure and stop it from coming out.

The insertion procedure takes around 45 minutes. We use local anaesthetic and most patients do not find it very painful.

Why we recommend an IPC for you

Usually, there is a small amount of fluid (15 to 30ml) in the pleural cavity. Sometimes a larger amount of fluid collects in the pleural cavity. 

When a larger amount of fluid collects, your lungs cannot work properly and you become short of breath.

Long-term benefits of an IPC

Draining away the fluid can help with your breathlessness for a short time, but the fluid often builds up again.

If you have an IPC, a district nurse can come to your home to help drain the fluid that develops. Some patients and their carers can learn how to drain the fluid themselves without the need for nurses to visit. An IPC means you do not need to keep coming back into hospital for repeated drainage. 

In many patients, the IPC is able to seal the space between the chest wall and lung, and this prevents the fluid from coming back.

We remove the IPC if you no longer need it.

Alternative to an IPC

For some patients, we can drain all the fluid in their pleural cavity. Although this can help with their breathing, the fluid can keep returning, which requires the patient to make more visits to hospital.

For a number of these patients (but not all), we may be able to admit them to hospital and provide treatment to help stop the fluid returning. We can discuss this with you, if needed.

Preparing for the procedure

You can eat and drink normally before your procedure. We advise you to have a light breakfast in the morning.

Blood test

You will need a blood test to check that your blood clots normally. We will let you know if you need to complete this blood test before your procedure. To book your blood test:

• use this link: Blood tests, Kingston Hospital
• or call: 020 3870 5766

Medications

You may need to stop taking some of your usual medications before your procedure, if they increase the risk of bleeding. We will let you know when to stop taking them and when to restart them. Examples include the following:

• aspirin
• apixaban
• clopidogrel
• dabigatran
• heparin
• rivaroxaban
• warfarin.

During the procedure

You can expect the following during the procedure.

• We ask you to remove your clothing from above the waist and change into a hospital gown.
• We ask you to lie on your side.
• We perform an ultrasound scan of your chest to find the best place to insert the IPC.
• We use a local anaesthetic to numb your chest wall. This may sting slightly for a short time.
• We make small incisions (cuts) in the numb area of your chest so we can insert the IPC. This will be painless, but you may feel a tugging sensation.
• We insert the IPC, use stitches to secure it and cover it with a dressing. Your GP practice nurse or district nurse can remove these stitches after about 2 weeks.

Recovery at home

Most people go home on the same day as the IPC insertion.

Pain/itching

You may experience pain and redness around your IPC during the first few days. This is normal. Your chest may feel bruised or sore. This can last up to 1 week.

We advise you to take your usual over-the-counter painkillers, such as paracetamol.  You may be able to take ibuprofen as well, but we advise against ibuprofen if:

• you have a kidney condition
• you experience stomach ulcers
• you are on blood thinners.

Check with  your doctor if you are unsure and always follow the instructions on the painkiller packaging.

People often experience itching for the first few days. You can try taking over-the-counter antihistamine tablets to reduce the itching.

Washing/wound dressings

We will use a dressing to cover the area where we insert the IPC. As long as you keep the insertion site clean and dry, you can take a shower. Most patients find it easiest to use a handheld shower.

Change your dressing if it feels loose after a shower.

You may choose to shower just before you drain the wound, when you (or your district/GP practice nurse) will be changing your dressing anyway.

After 2 weeks you can shower and bath. After your shower or bath, make sure the wound site is clean and dry, and put on a fresh dressing.

Your district nurse can supply you with extra dressings.

Everyday activities

• For 2 weeks afterwards, stick to gentle activities such as walking, light housework or light gardening.
• Avoid any activity (including contact sports) that can disturb the IPC or cause the dressing to be pulled off by accident.
• After 2 weeks most patients return to their usual routine of activities. 
• After 1 month, you will be able to go swimming if your entry site is healing well. Make sure you keep the dressing and the entry site clean. If necessary, replace the dressing after you swim.
• Avoid leaving a wet dressing in contact with your skin or the IPC.

Draining the fluid at home

• Most people find draining to be an easy procedure.
• Your district nurse will show you how to drain the fluid for the first time. Use the supply of IPC bottles we give you to take home.
• If you prefer, someone you know can regularly drain the fluid for you.
• People usually drain their fluid 2 or 3 times a week.

Bottle supply

We will give you 2 or 3 bottles to take home. This is enough for 1 week of fluid drainage.

We will send your GP a letter, asking them to prescribe extra bottles and wound dressings, which you can collect from your local pharmacy.

Check with your GP/pharmacy to make sure that your bottles will be ready. (It can take a few days for bottles to arrive).

We will give you a drainage booklet which includes information on looking after your IPC and ordering extra bottles. You can also use this booklet to record how much fluid you drain from the IPC.

If fluid stops draining

If the fluid stops draining, it may mean your IPC is blocked. Get in touch with your Lung CNS (clinical nurse specialist) if this happens. 

If you find you are gradually draining less fluid over days or weeks, it may mean you are producing less. Get in touch with your Lung CNS to let them know. 

Changes in fluid colour 

Changes in fluid colour can be normal. Make a note of this change of colour in your drainage diary, so we can review it at your next appointment.

Contact your Lung CNS if you have any concerns.

Risks

IPC insertion is a routine procedure. It is safe for most patients, but there are some risks.

Sometimes we are not able to insert the IPC as planned. If this happens, we will let you know if we plan to try again on another day, or discuss alternative treatment for you.

During or shortly after surgery

In the days or weeks after surgery

Risks of having a long-term IPC

The main risk is infection in your chest. Always follow the instructions on how to look after your IPC. This will reduce the risk of infection.

• Check the area regularly for signs of infection. Signs include redness, swelling, oozing pus or liquid, pain or a high temperature (fever).
• Tell your district nurse, GP or lung CNS as soon as possible if you experience these symptoms. You may need treatment with antibiotics.
• Tell your doctor if you get a lump or any pain around your catheter in the weeks after we insert it.

Follow-up

• The Kingston Hospital Pleural Clinic will offer you a telephone clinic appointment 4 to 6 weeks after we insert the IPC.
• You will need to arrange a chest X-ray just before this appointment. You can use the Kingston Hospital Walk-In X-ray service to have your X-ray (Monday to Friday, 08.30 to 5 pm). You do not need to book ahead for this.
• Your telephone appointment cannot go ahead unless you have had your X-ray. 

More information

NHS information for anyone with breathing difficulties caused by a cancer-related collection of chest fluid:  My pleural effusion journey