Tunneled peritoneal catheter placement in palliation of malignant ascites

PL Kwok1, TC Liu2, CY Wong2, S Soong2, YTA Lai1

1 Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
2 Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
Objectives Methods
Tunneled/ indwelling peritoneal catheter (IPC) is a long term alternative to A single centre retrospective review of patients who underwent IPC
conventional large volume paracentesis or pigtail catheter insertion (which insertion in a 3-year period from 2019 to 2022, covering age, primary site
require repeated hospital admissions with limited symptom control in of malignancy, pre-procedural consultation, procedural record and post-
between procedures) in malignant ascites. procedural outcome.
Results Rocket IPC silicone
catheter 16FG with Ideal insertion site: right
Total number of patients: 9 preattached metal
16Fr tearaway flank, 6-10cm below
Tunnelling tunneller
forceps sheath/dilator costal margin
Age range: 49-78 18G guidewire
Foam insertion
Primary site of malignancy: ovarian, breast, pancreatic, lung cancers and catheter needle 5cm tunnel created
pad
cholangiocarcinoma
Drainge line Free aspiration of ascites
A multidisciplinary team approach with pre-procedural counseling, post- from catheter insertion
procedural patient education and follow up visits. Valve cap site
J-tip
All patients tolerated the procedure well without the need for guidewire
intraprocedural sedation. IPC catheter through
tunnel until cuff is
Technical insertion success rate: 100% midpoint in the
subcutaneous tract, cut
off tunneller

16FG sheath/dilator over

Exit site Insertion
site guidewire into peritoneal
Cuff
space, depth no more
than 7cm, withdraw
guidewire

Feed fenestrated end of

catheter into sheath and
advance into peritoneal
Outcome space

Peel away and remove

sheath

Drainage frequency depended on symptoms and fluid reaccumulation rate. Sheath Dressing
Suggestions for improvement and further plan of development
-More comprehensive education and discussion with patients and their
families for better patient selection, to avoid carer issue after IPC insertion.
-Extend service to home drainage (currently short-term admission for Conclusion
drainage) with more case experience.
IPC is a good alternative in refractory
-Develop an established IPC program with regular medical review, malignant ascites management,
community nursing support and expert troubleshooting advice. potentially improving end-of-life care.

References
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