[Valorie D]

1. We've got a couple of patients that are getting abdominal centesis every week or so. This can be pretty time consuming and stressful to the patient/family.
We were wondering of anyone uses a permanent indwelling drain. something that could be accessed 'at home', by the nurse and drained prn?
2. Was told there are some urinary catheters that are impregnated with an antibacterial solution to minimize UTIs in patients that have long term catheters.
In the same topic does anyone have suggestions for patients that catheters that continually clog with sediment?
3. Looking for a form that documents medications left in home (acknowledge the meds left).
Thanks,
Val
Harney County Home Health/Hospice
'The littlest agency in the nation'

[earle58]

i've never heard of permanent paracentesis sites....i always thought the md did it at the bedside using a large guage needle. this is someting new to me.

as for catheters getting clogged, if continuous irrigation or a larger size catheter doesn't work then i'm at a loss.
of course you want to r/o infection which could leave alot of sediment in the urine.

sorry couldn't be more help.

leslie

[janfrn]

I've seen a couple of ways to do multiple paracentesis. When my son was in PICU after his liver transplant and was in MODS, he was needing them several times a day. One of the resident physicians cobbled together a system that allowed for a single puncture and multiple drain cycles. He used a long 18g angiocath to access the fluid pocket and then sutured it to the skin. A stopcock, some IV tubing and an empty 5L dialysate bag were the collection system. The stopcock was attached to the hub of the angiocath, the tubing to the stopcock and the bag to the tubing. The tubing was taped to his abdomen, the bag placed on a blue pad on a footstool under the bed. When the ascites built up to the needs-to-be-drained-now stage, the stopcock would be open and the fluid would run out into the bag. The other way to drain off accumulating fluid is to place a Tenckhoff catheter (used for peritoneal dialysis) which can be opened and closed as often as needed. It's simply attached to a urine collection set. But this approach requires surgical intervention.

The only cure I know of for frequently-blocked Foleys is to irrigate it regularly. Or else change it. Irrigation is more cost effective.

[aimeee]

I was talking to a rep about the pleurx catheter and I believed he mentioned that there has been some use of them for those who need abdominal drainage. At >$50 a pop, its not a cheap option, but it is simple to use and something patient/family can handle themselves.

http://www.jvir.org/cgi/content/abstract/12/3/373

http://www.denverbio.com/physician_pleurx_catheter.html

[NRSKarenRN]

Originally Posted by Valorie D

1. We've got a couple of patients that are getting abdominal centesis every week or so. This can be pretty time consuming and stressful to the patient/family.
We were wondering of anyone uses a permanent indwelling drain. something that could be accessed 'at home', by the nurse and drained prn?
2. Was told there are some urinary catheters that are impregnated with an antibacterial solution to minimize UTIs in patients that have long term catheters.
In the same topic does anyone have suggestions for patients that catheters that continually clog with sediment?

1. I have info at my office + nursing procedure for home paracentesis drainage via type of dialysis catheter (forget name)---will post tomorrow.

Tenkoff catheter--- I think.

2. Silicone catheters are recomended for clients with long term catheter use.

3.Frequent cloging: Increase fluid intake if on on restriction. Some people do well with unsweetened cranberry juice; cranberry capsules have better effect without sugar content. Irrigation with acetic acid or just nss helps some people.

Frequent postition change, keeping catheter bag below bladder level and emptying when 1/2 full also help prevent urine stagnation in bladder outlet.

[NRSKarenRN]

Two good books by Diane Kaschak Newman, Incontinence NP:
The Urinary Incontinence Sourcebook
Managing and Treating Urinary Incontinence

[Valorie D]

Some really good information.
Thanks so much. Val

[skd1019]

Just last month I sent a patient out to a local hospital to have a catheter implanted for paracentesis. It is a type of dialysis catheter, although the record I received from the O.R. (outpatient surgery) when my patient returned didn't give a specific name (simply referred to it as a "65cm pig-tail dialysis catheter") It is a simple tube with a clamp near the end, and a small cap at the tip. Every other day we attach a foley bag, and allow it to drain for 1 hour. It is very simple to use. I should also mention that we had a bit of difficulty finding a surgeon to do the procedure. However, being able to spare the patient from having to be tapped Q6days was well worth the effort. Hope this helps.

[NRSKarenRN]

Guidelines for Ascites Drainage Using Tenkoff Catheter
for homecare patients
Procedure Reviewed with Ursella RN, Hahneuman Univ. Transplant Clinical Educator

Gather supplies: masks, dressings, paracentesis tray, gloves, tape etc.


Sterile procedure to be followed during procedure.

• Patient, RN and caregiver in immediate area to wear masks.
• Patient / RN wash hands using antimicrobial soap using surgical scrub technique
• Surgical prep skin area and catheter exit site/cap for minimum of one minute w/betadine. (use Hibiclens/Accept solution if betadine allergy)
• Prepare sterile field. Open paracentesis tray, attach paracentesis tubing to 2 Liter drainage bag.
• Insert needle connection into huber cap of catheter. Open Tenkoff catheter clamp to allow gravity drainage of fluid into bag. Record amount of drainage and fluid characteristics, any symptoms reported by patient. Report any signs and symptoms of infection to physician.
• Close clamp. Disconnect + dispose of needle/tubing in sharps type container.
• Dispose of ascites fluid into toilet.
• Apply DSD to catheter exit site-patient to change daily prn.
• Goal is to have patient/caregiver perform procedure independently.
• Weights not indicated at this time.

See article:
Malignant Ovarian Ascites Can Be Draining
Marylisa Kissinger, RN, BSN
Nursing Spectrum Masthead Date August 25, 2003
http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=10277

[angieRN]

Have seen two instances of this just in the 1 year I have been doing hospice. One person who had it done, it was referred to as a TIPS procedure (Transjugular Intrahepatic Portosystemic Shunt). He had cirrhosis and it was connected to a colostomy type bag over where the stent was placed. There was no external equipment other than the drainage bag. It just looked like a little tunnel into his abdomen. Didn't get to know too much about it as the patient died less than 24 hours after admission.

2nd patient who I saw had the dialysis-type catheter with a clamp and IV cap on the end. I believe she was an ovarian CA with mets to multiple sites. She cleansed the insertion site with sterile gauze and saline and dressed with a drain sponge which she changed each day. Approximately every day she would insert an 18g. needle into cap and use gravity to drain all that she could into a container. Then she flushed the catheter with a 10cc to 1/2cc of saline and 100u heparin to keep the catheter from clotting. I would change the cap using sterile technique once a week. She was always much more comfortable after draining.

Hope this info helps!
Angie