My Drainage Catheter

What is a drainage catheter?

A drainage catheter is a small, flexible tube with little holes at the end of it to allow fluid to be drained off an area. No one wants a drainage catheter, but now that you’ve got one, there are a few things that you should know. This guide provides information so that YOU can participate in the ongoing care of your drainage catheter. By participating in the care of your drainage catheter, you will shorten the length of time that you’ll need it, and have it removed sooner.

Why was a drainage catheter placed?

Your drainage catheter was placed so that internal fluid could be continuously drained out of your body. The fluid itself may or may not be infected, but needs to drain for a while. There is a suction bulb that pulls fluid through the drain and collects into the bulb. The fluid amount should be measured and then discarded. Drainage should be continuous – that is, the drain and the bulb should be working so that all available fluid can be removed any time it recollects.

Causes of internal fluid can vary, but most commonly it is due to an abscess (infected fluid) or a seroma (non-infected fluid created from inflammation). It can occur in any part of the body.

An abscess is a collection of infected fluid, or pus, within the body. It often causes localized pain, fever and malaise. Although antibiotics are effective in treating most infections, they sometimes cannot effectively penetrate in these fluid collections. Therefore for successful treatment of the infection, it is important to remove the pus in order for the antibiotic to work more effectively. This is when a drainage catheter becomes beneficial.

A seroma is a collection of clear serous fluid that sometimes develops in the body after surgery or an injury. This fluid is made up of blood plasma that has seeped out of injured small blood vessels and fluid produced by injured and dying cells. This fluid is not infectious and the body is usually able to reabsorb them. If not, and/or the seroma is causing symptoms (pain, fullness), it may be beneficial to have a drainage catheter placed.

How do I take care of my catheter?

Caring for your drain is easy. If there is not much drainage, you can empty the bulb once each day. Otherwise you may need to empty it 2 -3 times per day, recording the amount each time.

Squeeze the bulb flat and close the drain plug so that the suction works again.

Keep the drain site clean with soap and water, or peroxide. Make sure to replace your dressing with a new, clean and dry bandage over the drainage catheter entry site into the body. A great bandage is the 3M Medipore +Pad Soft Cloth Adhesive Wound Dressing as it does not irritate that skin as much and it is easy to change.

Most patients should be able to return to their normal activities after 1 week after drain placement.

We recommend no contact sports or strenuous activity while you have the drain, and for a period of approximately 1 week after removal of the drain to minimize the chance of bleeding.

What to expect from your drainage catheter?

There is no “right” color or consistency of the fluid. If the fluid is not infected, it is usually clear and often golden or pink in color. Infected fluid ranges from cloudy to opaque, and may be thin or thick and creamy, yellow, green, brown, or gray. As fluid drains, it is hoped that the amount that is collected each day will decrease. It is important to record the daily “output” from your drain so that the amount of fluid that drains can be tracked over time. It’s possible that as the amount of fluid diminishes, there may be no drainage at all.

When there is no drainage, there are two possibilities – the fluid may be completely gone, or the drainage system may be incapable of removing fluid (clogged tube or no suction). Provided that there is little fluid left to drain, the drainage catheter is usually removed when the output drops to less than 20 mL per day and/or when the fluid is no longer considered to be infected.

When should I flush the drain? How do I do it?

You may be instructed to flush the drain, particularly if the fluid is thick. Most patients should flush their drains daily. This will keep the drain from becoming clogged ( with re-accumulation of fluid in the body and a delay in ultimate removal of the drain ). Learning to flush the drain takes some simple training, but once you understand the procedure it is easy and takes 5 minutes.

There should be a 3-way stopcock or a “Y-shaped” flush adapter in the line between the drain and the bulb. If you’ve done it right, the bulb will suck the fluid from the drain, and you will see the fluid in the tube that leads to the bulb.

How to flush using a 3-way stopcock:

1. Remove Sideport cap and clean port with alcohol swab

2. Attach flush syringe to Sideport.

3. Turn dial clockwise so “off” is pointing towards the bulb

4. Inject 5-10 mL of saline or sterile water

5. Turn dial counter-clockwise so “off” is pointing back to the Sideport (where the syringe is attached)

6. Remove syringe and replace cap to Sideport.

7. Ensure bulb is compressed to allow for continuous suction.

How to flush using the “Y-shaped” flush adapter:

Pinch clamp on tubing to stop flow to bulb.
Clear flush port with alcohol swab and attach flush syringe to flush port
Inject 5-10 mL of saline or sterile water
Remove flush syringe
Unclamp the pinch clamp to allow flow to bulb
Ensure bulb is compressed to allow continuous suction

How to empty the drain?

1. Wash your hands well with soap and water.
2. Pull the plug on the side of the bulb out of the bulb.
Pour the fluid inside the bulb into a measuring cup. Measure how much fluid you collected. Write the amount of your drainage and the date and time you collected it on a drainage chart. Flush the fluid down the toilet.

3. Clean the plug with alcohol. Then squeeze the bulb flat. While the bulb is flat, put the plug back into the bulb.

4. The bulb should stay flat after it is plugged so that the vacuum suction can restart. If you can’t squeeze the bulb flat and plug it at the same time, use a hard flat surface (such as a table) to help you press the bulb flat while you replug it.

5. Wash your hands when you are done.

How to care for the skin and the drain site?

Wash your hands well with soap and water.
Remove the dressing from around the drain. Use soap and water or saline or peroxide on a gauze pad/cotton pad. Clean this area once a day.
When the drain site is clean and dry, place a new dressing around the drain. Put surgical tape on the dressing to hold it down against your skin. This helps present the drain from tugging your skin.
Place the old dressing into the trash. If it is bloody, wrap it in a small plastic bag.
Wash your hands.

When can the drainage catheter be removed?

The recovery time varies depending on what the fluid is. Usually we wait until the daily drainage is less than 20 mL a day. This is to minimize the chance of recurrence. That is why it is very important to record your daily output.

If it is an abscess, the drain may need to stay in place until the culture results from the fluid comes back and confirms what type of antibiotics should be taken.

Culture results typically take 3-5 days. Once you’re on the appropriate medication then your drain output should be decreasing and becoming less like pus and more like thin, clear or clear-pink fluid.
As fluid drainage decreases to <20 mL a day and is a thin, clear fluid, then it can be removed. This can vary from days up to a few weeks.

If it is a seroma, the drain will need to stay in place until fluid drainage is <20 mL.

In some cases, fluid continues to collect for over a week at >20 mL a day.
Medication may need to be administered through the catheter to try and “shrink” down the pocket that the fluid is collecting in.

How is the drainage catheter removed?

The drains are usually removed in the office. It is a very quick and simple procedure that has minimal pain. It does not require sedation or anesthesia. Your drain has a suture attached to your skin that is removed along with the catheter and a suture inside the catheter.

Complications:

Leaking around the drain: sometimes, a large amount of fluid may leak from around the drain site, making the gauze dressing completely wet. If this happens, first flush the drain to be sure it isn’t clogged. Then, remove the dressing and use soap and water or peroxide to clean the area. Verify that the bulb drain is secured and that the bulb is “flat” to provide the needed suction.

Clogging of the drain: you could develop a clog within the drain. This may appear as a stringy plug. It could prevent the drainage from flowing through the tube. You can “milk” this clog along the tube by “stripping” it – pinching the tube and sliding your pinched fingers toward the bulb or you can flush it into the bulb using a 5-10 mL flush and turning the stopcock so that the fluid is pushed into the bulb (off position pointing towards the drain/your body).

As your internal fluid collection drains, the cavity where the fluid formed gradually collapses. Sometimes a small amount of blood enters the fluid as this happens. Do not worry if there is a small amount of blood as long as the drain is free from clogging. However, if there is obvious bleeding that fills the bulb, contact your interventional radiologist at (650) 404-8445 daytime, or go to the emergency room if there is a lot of bleeding or sudden pain.

What should I watch for?

You may be sore after the procedure. However, the pain should not get worse and should subside in 2-3 days. If you develop severe pain, fevers >102 F, substantial bleeding or leakage at the drain site, you should seek immediate medical attention at your closest emergency room. If pain seems to be getting gradually worse, if you develop a low grade fever or chills, or if the drain becomes dislodged, you can call us at (650) 404-8445 Monday thru Friday between 8am-5pm, or reach the on-call Interventional Radiologist by calling (408) 739-6000.

General Instructions:

Sedation

If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Activity

You may resume your regular activities ( including driving ) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.

Pain Management

You may use over the counter medication such as Acetaminophen ( Tylenol) or Ibuprofen ( Advil /Motrin ) for minor discomfort, unless you are restricted from taking these medications.
For more severe pain, we gave you a prescription for Norco ( Hydrocodone + Tylenol ), which is a narcotic medication.
You should also take Colace ( a stool softener ) daily while taking the narcotic medication to prevent constipation, which is a common problem while taking pain medications.

Diet

You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

Shower

You can take a shower tonight.
DO NOT WORRY IF THE TUBE GETS WET.
After showering, you should remove the dressing, dry the area and apply a new dressing.
You should not soak the wound in water ( ie. bath and swimming pool ).

Tube

There is risk the tube can get clogged and then the tube should be flushed; see the instructions above.
You should call your interventional radiologist if there is blood that is thick enough that you cannot see through the tube or bulb for more than 24 hours.

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