Section C:
Insertion of an Indwelling Pleural Catheter
Anna C. Bibby and Nick A. Maskell
Academic Respiratory Unit, University of Bristol, UK
Indwelling pleural catheters (IPCs) can be inserted in awake, non‐sedated patients using local anaesthetic. The procedure should be performed in a clean environment such as an operating theatre or dedicated procedure room.
A step‐by‐step guide to IPC insertion
- The patient is positioned in the lateral decubitus position (pleural effusion side up) and a thoracic ultrasound performed to confirm the presence of fluid. A suitable insertion site for the drain is chosen and marked. A second site is marked, anteriorly and inferiorly, where the catheter will exit the skin. This is usually approximately 7 cm from the insertion site. Patient comfort and ease of access to the drain should be considered when choosing the exit site. In females, the position of the catheter in relation to their bra straps should also be considered.
- The skin is sterilised, drapes are positioned and local anaesthesia infiltrated (Figure 10.12).
- A small incision, measuring 1–2 cm laterally, is made at the insertion and exit sites. The introducer needle is inserted into the pleural space at the insertion site, entering the pleural cavity by travelling directly over the top of a rib. Pleural fluid should then be aspirated freely before proceeding with the next part of the procedure (Figure 10.13).
- The syringe is removed from the introducer needle and a guidewire passed through the needle into the pleural space. The guidewire remains in situ as the introducer needle is removed (Figure 10.14
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