Implantation – step by step
1. Locate the fluid by ultrasound and mark the places for incisions.
2. Disinfect a large area (about 25 x 30 cm) around the desired catheter placement with chlorhexidine alcohol.
3. Cover a large area with 4 sterile drapings (full body draping). The opening should be 20 x 25 cm.
4. Generously apply local anaesthetic both in the puncture channel and in the entire tunnelling channel and let it work.
5. Insert the guidewire introducer with needle and syringe, aspirate to remove fluid. Leave the guidewire introducer in place. Remove the syringe with needle.
6. Insert the guidewire through the introducer (Seldinger technique) and then remove the introducer. The guidewire is 60 cm long. Only advance as much as you need.
7. Make a first incision at the guidewire insertion site, about 1-2 cm wide and deep.
8. Second incision about 5 cm away from the first incision in case of pleural catheter, or 8 cm in case of ascites catheter. About 1-2 cm wide and deep.
9. Tunnel the catheter towards the guidewire (from the 2nd to the 1st incision). Place the polyester cuff in the middle of the tunnel to start with. Remove the tunneler from the catheter when tunnelling is complete.
10. Thread the dilator with introducer over the guidewire. Make sure that the guidewire comes out of the rear end before the dilator is inserted into the body, so that it does not slide into the body. Once in place, the guidewire and dilator are removed, leaving only the introducer sheath. Place a thumb at the top of the introducer to prevent too much fluid from leaking out (do not squeeze the introducer).
11. Insert the catheter through the introducer sheath as far as possible.
12. Peel away the sheath step by step. Make sure the catheter is kept in place during this time. Adjust the position of the catheter in the tunnel when the introducer is removed. The polyester cuff should be about 1 cm into the tunnel from the catheter exit site.
13. Connect a drainagebag/-bottle to check free flow and perform a drainage.
14. Close the incision at the guidewire insertion site. Close the incision site around the catheter. This fixation suture is attached to the skin and wrapped around the catheter about 0.5 cm above the skin. Make sure it is tight around the catheter but do not restrict the diameter of the catheter. The skin suture can be removed after 10 days, but the drain fixation suture must remain in place for at least 30 days.
15. Disconnect the drainage bag/bottle and put a cap on the catheter. Then a wound dressing is applied. If the patient is to be drained again within a week, the valve with cap can be left outside under an additional bandage.
