Management of Malignancy-related Ascites

Anne Marie C. Flaherty, MSN, RN, APNc, AOCNS®


Oncol Nurs Forum. 2015;42(1):96-99. 

In This Article

Principles of a Home Drainage System

Effective and safe ascites drainage in the patient with malignant ascites is a priority to palliate this distressing symptom. It was identified that a catheter that could be easily inserted and adequately drain ascites with minimal complications was needed (see Figure 1). Systems that were used for drainage of pleural effusions in an outpatient setting and at home were then applied to malignant ascites. The physical characteristics that were needed were a tunneled cuffed catheter with a one-way valve to reduce leakage around the catheter and infection rate and a closed-drainage system that accesses the one-way valve, which would further decrease infection. The drainage system also needed to be one-time use and disposable. Two drainage systems that met these requirements were the Aspira® and PleurX® systems (see Figures 2 and 3). Both are FDA approved for the management of malignant ascites.

Figure 1.

Tunneled Catheter With Aspira® System
Note. Image courtesy of C.R. Bard, Inc. Used with permission.

Figure 2.

Aspira® Drainage System
Note. Image courtesy of C.R. Bard, Inc. Used with permission.

Figure 3.

PleurX® System
Note. Image courtesy of CareFusion Corp. Used with permission

The design of the catheters and insertion technique has reduced leakage around the catheters, which was a major issue with the Tenckhoff catheters (Shuman, 2008). Leakage led to skin maceration and superficial cellulitis. The superior-lateral insertion and coating of the catheters also reduces leakage during and after insertion. The one-way valves on the distal end are an intrinsic part of the catheters, resulting in less manipulation changing the valves or caps, as was required with the Tenckhoff. These valves lock into the drainage tubing, providing a closed or one-way drainage system and a simple process for the patient and caregiver, which further reduces the risk of infection (Behrendt, 2008).

Both systems also provide facilitation of drainage with vacuum-enhanced technology. The Aspira system has a low-vacuum, siphon-activating pump built into the drainage tubing that, when pressed and activated, promotes drainage of the ascites. PleurX uses a vacuum bottle that, when the tubing is inserted, the vacuum is activated. The systems also provide clamps on the tubing so that accidental breakage of the catheter occurs, the system can be sealed. Drainage can be completed in as little as 15 minutes. Both systems have maximum drainage capacity of 1,000 ml. If a larger volume is needed, a second drainage system would be used. The exit site of the catheter requires routine dressing changes and both Aspira and PleurX provide dressing supplies. Dressings should be changed weekly or if they become wet, dislodged, or saturated with drainage. Shuman (2008) recommended the Aspira system, saying it was less cumbersome and less costly, however, Behrendt (2014) preferred the PleurX system for its efficiency in drainage.