What type of catheter is used for ascites drainage?

Catheters Used for Ascites Drainage

For ascites drainage, a large-volume paracentesis catheter is the standard procedure, typically using a multi-side-hole catheter inserted via the "Z-track" technique. 1 For patients requiring frequent drainage, tunneled peritoneal catheters may be used for long-term management.

Types of Catheters for Ascites Drainage

Standard Paracentesis Catheter

• Used for single-session therapeutic drainage
• Features:
  • Multiple side perforations to prevent blockage by bowel wall
  • Typically inserted in left or right lower abdominal quadrant
  • Inserted using "Z-track" technique (perpendicular skin penetration, oblique advancement through subcutaneous tissue)
  • Temporary placement only (not left overnight)
  • Removed after complete drainage (usually 1-4 hours) 1

Tunneled Peritoneal Catheters

• Used for refractory ascites requiring frequent drainage
• Types:
  • Tenckhoff catheter (multiple side-holes) 2
  • Tunneled peritoneal drainage catheter (similar to PleurX) 3
  • Permanent-tunneled peritoneal catheter 3
  • In some cases, central venous catheters have been adapted for peritoneal use 4

Indications for Different Catheter Types

Single-Session Paracentesis (Standard Approach)

• First-line treatment for large or refractory ascites 1
• Appropriate for patients who need occasional drainage
• Performed as a complete drainage in one session 1

Tunneled Peritoneal Catheters

• For patients requiring frequent paracentesis (>3 per month) 1
• For refractory ascites with contraindications to TIPS 3
• For malignant ascites (particularly beneficial) 2, 5
• For patients who would benefit from home-based drainage 3

Procedure Details

Standard Paracentesis

1. Performed under strict sterile conditions
2. Catheter inserted using Z-track technique
3. Complete drainage performed in a single session (1-4 hours)
4. For large-volume paracentesis (>5 liters), albumin infusion (8g/liter of ascites removed) is recommended after completion 1
5. Patient should lie on opposite side for two hours after procedure if leakage occurs 1

Tunneled Catheter Placement

1. Typically placed using a modified Seldinger technique
2. Can be performed under fluoroscopic and ultrasound guidance 5
3. Creates a subcutaneous tunnel to reduce infection risk
4. Allows for repeated home drainage without hospital visits 3, 2

Clinical Considerations

Advantages of Tunneled Catheters

• Reduces need for frequent hospital visits
• Decreases diuretic requirements 3
• Maintains stable kidney function, serum sodium, and albumin levels 3
• Improves quality of life in patients with refractory ascites 3, 2

Potential Complications

• Catheter malfunction/occlusion
• Leakage at insertion site
• Cellulitis of tunnel tract
• Peritonitis (though relatively uncommon) 5

Special Situations

Malignant Ascites

• Tunneled peritoneal catheters are particularly beneficial
• Allow for home-based palliative drainage
• Provide symptom relief with minimal hospital visits 4, 2

Non-Malignant Etiologies

• Can be used in end-stage liver disease and heart failure 5
• May serve as a bridge to liver transplantation 3

For patients with refractory ascites who don't respond to medical management, the choice between repeated paracentesis with a standard catheter versus placement of a tunneled peritoneal catheter should be based on the frequency of required drainage and patient-specific factors such as mobility, home support, and prognosis.