Indian Journal of Palliative Care
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LETTER TO EDITOR
Year : 2020  |  Volume : 26  |  Issue : 3  |  Page : 394

Innovative method to deal with pericatheter leak in home-based management of malignant ascites


Department of Anaesthesia and Palliative Care, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Date of Submission13-Dec-2019
Date of Acceptance31-Dec-2019
Date of Web Publication29-Aug-2020

Correspondence Address:
Praneeth Suvvari
Department of Anaesthesia and Palliative Care, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPC.IJPC_199_19

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How to cite this article:
Suvvari P, Nair A, Anne P, Rayani BK. Innovative method to deal with pericatheter leak in home-based management of malignant ascites. Indian J Palliat Care 2020;26:394

How to cite this URL:
Suvvari P, Nair A, Anne P, Rayani BK. Innovative method to deal with pericatheter leak in home-based management of malignant ascites. Indian J Palliat Care [serial online] 2020 [cited 2020 Sep 21];26:394. Available from: http://www.jpalliativecare.com/text.asp?2020/26/3/394/293868




Sir,

Malignant ascites is an accumulation of fluid in the peritoneal cavity due to manifestation of terminal metastatic malignancies.[1] Ascites often is the cause for significant problems such as marked abdominal distention, anorexia, early satiety, dyspnea, nausea, fatigue, and lower-extremity edema compromising the quality of life (QOL).[2] The fluid often reaccumulates and may require repeated paracentesis (tapping of fluid) to palliate symptoms. Several methods have been tried for home-based management such as tunneled catheters (PleurX, Tenckhoff catheters, etc.) and nontunneled catheters such as pigtail and central venous catheter inserted into the peritoneal cavity.[3]

Tunneled catheters have limited availability in a resource-limited country like India. Hence, we manage malignant ascites patients in our setup with pigtail insertions (Indovasive P.C.N Catheter, Biorad Medisys Pvt. Ltd). Various complications have been reported with tunneled catheters in literature such as skin infection, pain around the catheter site, and pericatheter leak of ascitic fluid.[2],[3] While the former two complications can be managed adequately, pericatheter leak is a distressing complication as it causes malodor, wetting of clothes, and hygiene issues. We have implemented a well-practiced method to tackle this issue. Colostomy bags have long been used in surgical practice. We have placed colostomy bag (Hollister Ostomy, USA) around the pigtail at its site of insertion to collect the pericatheter drain fluid [Figure 1]. The patient is advised to drain the colostomy bag as frequently as needed. We have advised this procedure in two of our patients and both of them reported satisfactory outcomes.
Figure 1: Image showing colostomy bag applied around the site of insertion of pigtail catheter

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to acknowledge the patient's co-operation and trust on us.

Financial support and sponsorship

This study was supported by Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ratre BK, Suvvari P, Hoda W, Roychoudhury P, Bharti SJ, Bhatnagar S. Central venous catheter as peritoneal indwelling catheter for the management of recurrent malignant ascites: A case series. Indian J Palliat Care 2019;25:57-60.  Back to cited text no. 1
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2.
Courtney A, Nemcek AA Jr, Rosenberg S, Tutton S, Darcy M, Gordon G. Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. J Vasc Interv Radiol 2008;19:1723-31.  Back to cited text no. 2
    
3.
Maleux G, Indesteege I, Laenen A, Verslype C, Vergote I, Prenen H. Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: Technical results and overall clinical outcome. Radiol Oncol 2016;50:197-203.  Back to cited text no. 3
    


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