Long-term Drain for Ascites in Chronic Liver Disease

This leaflet explains what the procedure involves and the possible risks and complications you may experience. Your doctors will have discussed these with you, however, if you are still unsure about the benefits of having the procedure, please ask.

What is an LTAD?

A LTAD is a permanent tunnelled drain placed by a radiologist using ultrasound guidance. This allows the drainage of fluid from your abdomen at your home, reducing the need for you to attend hospital for each drain.

Why do I need a long term abdominal drain?

The symptoms of ascites can be very distressing. The abdomen becomes swollen and distended, which can be uncomfortable and painful. You may find it difficult to get comfortable, sit up or walk. It can make you feel tired or breathless and may cause feelings of sickness (nausea) or make you sick (vomiting). You may also suffer indigestion or reduced appetite. Your ascites can be managed by intermittent drainage at our day case unit or with the insertion of a LTAD.

Are there any risks or complications?

LTAD insertion is a very safe procedure, but as with any medical procedure, there are some risks and complications that can arise.

• Bleeding – minimised by checking your clotting prior to the procedure, managing your blood thinning medication (if you are taking it) and by using ultrasound guidance to place the drain.
• Bowel perforation – rare and again minimised by using ultrasound to guide placement.
• Infection – the drain is inserted under sterile conditions, and you will be commenced on prophylactic antibiotics, if not already taking these. Sometimes you may require different antibiotics to treat an infection of the skin around the drain site
• Leakage – occasionally there may be some leakage of fluid from around the drain site
• Blockage – occasionally the drain can become blocked. Sometimes we can unblock the drain but if that is not possible then the drain will need to be removed.

It is important that you and/or your caregiver is taught how to manage the drainage in a sterile manner, to reduce the risk of infection developing at a later stage.

The drain insertion

Who will be inserting the drain?

A doctor called an interventional radiologist. These doctors are able to see what they are doing by using ultrasound. They will be assisted by radiology nurses, who will look after you throughout the procedure.

Where will the procedure take place?

This procedure is carried out in a room in the x-ray (radiology) department.
You will be admitted to the Liver Day Case Unit and have your observations checked and a cannula inserted before being taken down to Radiology.
There a Radiologist will explain the procedure and discuss it with you before you sign the consent form.

What happens during the procedure?

An initial ultrasound scan will be performed to assess the area to be drained and mark a spot on the skin.

Under sterile conditions, the area will be cleaned with a cold antiseptic solution and the area draped with sterile drapes.

The radiologist will inject the area with local anaesthetic to make the procedure more comfortable for you.

There will be two small skin incisions made and the drain will be placed into position. A suture (stitch) may be put into the skin wound to encourage the skin to heal, and a dressing applied.

What happens afterwards?

• After the insertion of the drain you will return to the day case unit to be monitored whilst your ascites is drained. You will also be given albumin replacement.
• You will be taken back to the day case unit on a trolley.
• Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure to make sure that there are no problems.
• They will also look at the skin entry point to make sure there is no bleeding from it.
• You will generally stay in bed for a few hours, until you have recovered and we have drained as much ascites as we can.
• You will be discharged home the same day.
• The nurses on the ward can teach you or a relative how to look after the drain.
• A referral will have been made to the districts nurses in your community, who will visit you at home to check the drain.
• A copy of the management of your drain will be given to you and the Community teams.

Contact us

In the event of any complications that your community team cannot manage, you can contact: