Abdominal PleurX catheter

Ascites is fluid that collects inside the belly, in the space around the intestines and liver called the peritoneal cavity. A lot of fluid can make your belly swollen and tight. It can cause pain, early fullness when eating, constipation, trouble breathing when lying flat or walking, and swelling in the legs.

The usual treatment is paracentesis, where fluid is drained with a thin needle. It is quick and safe, but if the fluid returns within days, you may need it every week or more. A tunneled abdominal drain is a soft tube that stays in place, so you can drain small amounts at home as often as you need.

You may hear it called an abdominal PleurX catheter. The same company now also makes a version designed for the belly, called PeritX. They work the same way. On this page we call it a tunneled abdominal drain.

On ultrasound, ascites looks like black fluid surrounding gray loops of bowel. We look for a deep pocket, usually in the lower belly, with no bowel directly under the skin.

The most common reason is ascites caused by cancer, called malignant ascites, for example from ovarian, pancreatic, stomach, colon or breast cancer. Some people with liver cirrhosis or heart failure whose fluid no longer responds to other treatment may also benefit, especially when the focus is comfort.

Diuretics (water pills) and eating less salt help many people with cirrhosis, but they work less well for cancer-related ascites. For people with cirrhosis, a TIPS may control fluid better than a drain. We talk through all of these options with you and your other doctors.

The procedure is done at El Camino Hospital in the interventional radiology suite. A nurse, a technologist and your interventional radiologist are with you, and your heart rate, blood pressure and oxygen are watched throughout.

1. 1
   Getting comfortable

   You lie on your back. Moderate sedation through your IV helps you relax while you stay awake.

2. 2
   Numbing and planning

   We use ultrasound to find a safe pocket of fluid, usually on the lower side of the belly. The skin is cleaned and numbed.

3. 3
   Placing the drain

   A thin needle enters the fluid, and a guidewire goes through it. A second small opening is made a few inches away, and the tube is passed under the skin to form a short tunnel. It then slides over the wire into the belly.

4. 4
   First drainage

   The drain is connected to a vacuum bottle and fluid is removed. Your blood pressure is watched while it drains.

5. 5
   Closing up

   The first opening is closed with a stitch or glue. The tube is secured and covered with a waterproof dressing.

You recover for 30 to 60 minutes, and you can eat and drink right away. Before you leave, a nurse teaches you and a family member how to drain. You go home with a kit of bottles or bags and written instructions. More supplies are shipped to your home. If you need more, call us at 650-404-8445.

1. Day of procedure
   Take it easy. No driving, alcohol or important decisions if you had sedation. Soreness is normal; acetaminophen usually helps.
2. Next day
   Back to light activity and driving if you feel well. You may shower with the site covered by a waterproof dressing.
3. First week
   No heavy lifting, contact sports or strenuous activity. Drain as we instruct.
4. 7 to 10 days
   Skin stitches are usually removed in clinic or by a home nurse.
5. After 2 weeks
   The tunnel has healed. The site can get wet in the shower; pat it dry and put on a new dressing.

With ascites, I pay close attention to what matters most to the person in front of me. For many, it is simply being able to eat a meal and sleep lying down without coming to the hospital every week. On the ultrasound, I look for a deep pocket of fluid away from the bowel and from blood vessels in the abdominal wall, and I place the tube where it will sit comfortably under a waistband.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos