A guide to having an ascitic drainage : University College London Hospitals NHS Foundation Trust

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This page explains what an ascitic drainage is and what you can expect during the procedure, including the benefits, risks and any alternatives. If you have any questions about an ascitic drainage, please speak to a doctor or nurse looking after you.

An ascitic drainage is a procedure where the excess fluid (ascites) is removed from around your abdomen (tummy). This is done by inserting an ascitic drain into your abdomen using ultrasound scan for guidance. You will have local anaesthetic to numb the insertion site before the drain is put in. This means that you will be awake throughout the procedure but you will not feel any pain.

Most patients have a temporary ascitic drain which is removed on the same day. Some patients may have a semi-permanent drain which allows for fluid to be drained as needed. Your healthcare team will talk to you in detail about the type of drain you will have.

This image was originally produced by Macmillan Cancer Support and is reused with permission. Information correct at the time of publishing.

The fluid in your abdomen has caused it to swell which might have made moving and breathing more difficult or uncomfortable. Your healthcare team have recommended an ascitic drainage to relieve your symptoms.

As with any procedure, there are some risks of having an ascitic drainage. They include:

Infection around the drain insertion site. We will check your temperature regularly before, during and after the procedure as raised temperature can be a sign of infection.
Drop in blood pressure if fluid is drained too quickly. We will check your blood pressure regularly throughout the procedure as we slowly drain the fluid.
Bleeding from the drain site. This is very rare and we will monitor you for any signs of bleeding.
Accidental damage to the bowel or other abdominal organs. This is extremely rare as ultrasound scan is used for guidance.

Your doctor will talk to you in detail about the risks relevant to you and answer any questions you may have.

There are some alternatives available and your doctor will tell you more about each option. They include:

Medication such as a diuretic that can help your kidneys to remove the excess fluid. This may cause you to pee more.
Other medicines such as hormone therapy or chemotherapy that can help to shrink or control cancer cells. These treatments depend on the type of cancer you have and are not suitable for everyone.
A placement of a permanent internal shunt that drains the fluid into a large internal vein. This requires an operation under general anaesthetic.

The best way to relieve your symptoms from the fluid building up in your tummy is to have a drain inserted. If you choose not to have the drain, the fluid will continue to build up. This will cause discomfort, making it difficult for you to breathe, stay mobile, or eat and drink properly.

There are limited benefits of not going ahead with the procedure and your doctor will discuss them with you.

Your nurse or doctor will arrange for you to have a blood test to make sure it is safe to proceed.
They will ask you about any medicines you are currently taking.
Please tell your team if you are taking any anticoagulant (blood-thinning) medication. This is because you may need to stop it before your procedure. Examples include:
- heparin injection (such as enoxaparin)
- tablets (such as rivaroxaban, apixaban, edoxaban, dabigatran and warfarin).
You can eat and drink as normal before the ascitic drainage. But we recommend that you have a light breakfast and avoid dairy products on the morning of the procedure.
Wear loose comfortable clothes to your appointment.
Expect to be in hospital most of the day so bring your regular medication to take at the times you normally would.
You can also bring a book, magazine or tablet to help you pass the time.
Please arrange for someone to accompany you home after the procedure.

We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

We will ask you to come to the Imaging Department in the Tower (main hospital building) in the morning. We will send you a letter and/or text with the appointment time. It is important that you arrive on time.

A nurse will take your observations (blood pressure, temperature and pulse). Your doctor will then check your abdomen for fluid using an ultrasound machine and inject a local anaesthetic into the skin to numb it. This will cause some temporary discomfort but will wear off within a few seconds. Once the skin is numb, your doctor will insert a small drainage tube into your abdomen. This is usually pain-free. There will be a bag attached to the drainage tube to collect and measure the fluid.

A nurse will take your observations and arrange for you to be escorted to the Supportive Care Unit in the University College Hospital Macmillan Cancer Centre. The nursing team in the Supportive Care Unit will continue to monitor you and check your drainage bag. They will also encourage you to move around to help the fluid to drain.

The procedure is usually painless but occasionally you may feel some pain while the fluid is being drained. Please tell the team looking after you if this happens as we can give you some pain relief.

A nurse will remove your drain at around 4.30pm. This may be earlier if the fluid has stopped draining. After a dressing has been applied, you will need to stay in the Unit for around 30 minutes. Before you go home, your nurse will check that all is well and that you don’t have any pain. You may feel a little ‘washed out’ after the procedure, so you will need someone to travel home with you.

If you have a semi-permanent drain, we will show you how to care for it before you go home. We may be able to arrange a district nurse to visit you if you are having difficulties caring for your drain.

You should keep the dressing on for 24 hours. It is important that you keep it dry in that time.

You may have some pain at the drain insertion site. This should get better within one to two days. You can take your usual painkillers, such as paracetamol, to help with this.

It is normal to feel tired after the procedure so try to get some rest. Aim to drink 1.5 to 2 litres of water a day.

The symptoms listed below may be a sign of infection and you may need a course of antibiotics to treat it. If you notice any of them, please call your clinical nurse specialist (CNS) or the 24-hour oncology urgent advice line on 020 3447 3893:

leaking at the insertion site
redness or swelling around the insertion site
fever (temperature over 38 degrees)
chills or shivering
worsening abdominal pain.

Please note:

It is normal for the drain site to leak a little when you go home. Use the dressings provided and please contact us if this continues for more than 24 hours.

If you go home with the drain in, please contact us if your drain has moved or come out.

Please contact your CNS in the first instance for any queries or concerns.

If you have a paper copy of this page, you can complete the details below:

Name ……………………………………… Tel ……………………………………

Urgent advice line (24 hours)

020 3447 3893

Imaging Department

Podium Level 2,The Tower, University College Hospital, 235 Euston Road, London NW1 2BU

Tel: 020 3456 7002

Supportive Care

4th Floor, University College Hospital Macmillan Cancer Centre, Huntley Street, London WC1E 6AG

Tel: 020 3447 1800/1878