Permanent Paracentisis Sites

[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'

[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

[OneThunder, BSN, RN]

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'

I had a patient that the interventional radiologist place a "port" much like the ports used in chemotherapy, in the patients abdomen. The physician then accessed the port at bedside to drain the fluid build up.

[Valorie D]

I had a patient that the interventional radiologist place a "port" much like the ports used in chemotherapy, in the patients abdomen. The physician then accessed the port at bedside to drain the fluid build up.

Do you know the name of the port, or if there is a name for the procedure?

Thanks, Val

[OneThunder, BSN, RN]

Do you know the name of the port, or if there is a name for the procedure?

Thanks, Val

I will ask

[hissteps4u]

Permanent Cath's for Paracentisis are more common now adays paticularly with OV Cancer patients and other disease processes which are terminal and where the use of a permenent cath would be in their best interest. Certainly it is better to place one for those who's acities is a continual problem every few days. It is not uncommon at all to have patients only get Marginal releif for a few days and require another procedure. This way Families can be taught how to care for their Family member in their home where they are most comfortable and for those who are Terminal this is likely the most Humane thing to do to assist them with Palative care in the best way possiable. As a Hospice Nurse we often see these.. Care is relatively simple and easy to do.

[GrumpyRN63, ADN, RN]

I have had pts w/tenkoff caths, just like a denver/pleurx, just need larger collection containers, its pretty straightforward and convenient for the pt, some we had to drain QOD due to the lg amnt of ascites. About the foley issue, we have a couple that always clog w/gritty sediment, we teach the family how to flush, usually daily at a minimum w/ 30-60 cc's. really helps cut down the changing of the foley due to clogging

[finn11707]

I have had a woman with end of life cardiac disease with significant acites---she was going to out patient interventional radiology 2 x monthly for 4-5 liter draw off and not tolerating it very well...not wanting to be hospitalized overnight for monitoring...so we (the Hospice MD and RN Directors) approached the interventional radiologist about placing a longer term catheter--The interventional radiologist was hesitant at first, but places these frequently to managte liver disease acites. The tube can be bagged for gravity drainage and emptied as needed or connected to a pleurex catheter vacu bottle to drain 1000ml off in about 30 minutes. The kits are expensive, but not more than multiple monthly out patient procedures with over night monitoring. It is a procedure an able and willing caregiver could be taught to do also. It had made an incredible difference in the quality of life for my young cardiac patient. I am happy the Hospice team okayed it.