Dressing Management for PleurX Catheter Removal Site
After PleurX catheter removal, apply a sterile gauze dressing to the site and change it every 2 days until the site has healed, replacing it immediately if it becomes damp, loosened, or soiled. 1
Immediate Post-Removal Care
Skin Antisepsis
- Clean the removal site with 2% chlorhexidine gluconate in 70% isopropyl alcohol before applying the dressing 1
- Allow the antiseptic to air dry completely according to manufacturer recommendations before dressing application 1
- Use alcoholic povidone-iodine solution only if the patient has chlorhexidine sensitivity 1
Initial Dressing Selection
- Use sterile gauze dressing for the first 24-48 hours after removal, as the site will likely have some oozing or bleeding 1
- Gauze is preferred over transparent dressings when there is any bleeding, oozing, or moisture at the site 1
Dressing Change Protocol
Frequency
- Replace gauze dressings every 2 days until the site has completely healed 1
- Change the dressing immediately if it becomes damp, loosened, or visibly soiled, regardless of the scheduled change time 1
Transition to Transparent Dressing
- Once bleeding and oozing have resolved (typically 2-3 days post-removal), you may transition to a sterile, transparent, semi-permeable polyurethane dressing 1
- Transparent dressings can remain in place for up to 7 days if they stay intact and dry 1
- Replace transparent dressings sooner if moisture collects underneath or if the dressing loses integrity 1
Technique for Dressing Changes
Aseptic Procedure
- Perform hand hygiene before accessing the removal site 2
- Use sterile gloves when changing the dressing 1
- Clean the site with 2% chlorhexidine in 70% alcohol at each dressing change 1, 2
- Allow antiseptic to dry completely before applying new dressing 1
What to Avoid
- Do not apply topical antibiotic ointments or creams to the removal site, as they promote fungal infections and antimicrobial resistance 1
- Do not submerge the site in water (baths, swimming) until completely healed 1
- Showering may be permitted if the dressing is protected with an impermeable waterproof cover 1, 3
Monitoring and Assessment
Site Inspection
- Visually inspect the removal site at each dressing change for signs of infection 1, 2
- Look specifically for: erythema, warmth, purulent drainage, increasing tenderness, or wound dehiscence 2
- Document the integrity of surrounding skin and characteristics of any drainage 2
Red Flags Requiring Immediate Attention
- Remove the dressing for thorough examination if the patient develops: tenderness at the site, fever without obvious source, or other signs suggesting infection 1, 2
- Instruct patients to report any changes in the site or new discomfort immediately 1, 2
Special Considerations for PleurX Catheters
Infection Risk Context
- PleurX catheters carry a 2.2% to 38% infection risk depending on duration of use, with higher rates when catheters remain in place longer than 3 months 4, 5
- Post-removal site care is critical given this baseline infection risk 4, 6
- Most infections with indwelling PleurX catheters manifest as cellulitis at the insertion site 5, 7
Expected Healing Timeline
- The tunneled catheter tract typically heals within 7-14 days after removal 1
- Continue dressing changes until the site is completely epithelialized with no drainage 1
Common Pitfalls to Avoid
- Do not use excessive moisture that could macerate surrounding skin 2
- Do not leave the site without a dressing until it is completely healed and epithelialized 1
- Do not use chlorhexidine-impregnated sponge dressings (like Biopatch) after catheter removal—these are only indicated for indwelling catheters 1
- Do not allow patients to resume water immersion activities until the site is fully healed, even if it appears closed 1