Leg Fluid Drainage: Hospital Procedure Explained

Fluid can build up inside the body for many reasons, including infection, pregnancy, weakened valves in the veins, underlying medical conditions, side effects from medication, and poor nutrition. This condition is called edema, and it can cause severe lower extremity swelling, which is often difficult to manage in hospice patients. To drain fluid from legs, doctors may recommend a fluid aspiration and drainage procedure, especially if there is an abnormal collection of fluid causing severe symptoms. During this procedure, doctors insert a special needle into the fluid pocket to remove the fluid, using a CT scan, X-ray, or ultrasound for guidance. Patients are typically monitored for a few hours after the procedure and advised to avoid strenuous activity.

Fluid aspiration and drainage

During a fluid aspiration procedure, a doctor will insert a needle into the fluid pocket to extract a sample for laboratory testing. In some cases, all the fluid may be removed during the initial procedure, while in other cases, a drainage catheter may be left in place. This procedure is relatively safe, but possible complications include reactions to local anaesthesia, local bruising, minor bleeding, loss of skin pigment, and septic arthritis.

If a large amount of fluid needs to be removed or the fluid is too thick, a drainage procedure may be recommended. This involves passing a thin plastic tube through the skin, guided by a CT scan, X-ray, or ultrasound, to allow the fluid to drain out. This technique is often used in paediatric patients under general anaesthesia, and the tube is removed once most of the fluid has drained.

After a fluid aspiration or drainage procedure, patients are typically monitored for a few hours before being discharged. They are advised to avoid strenuous activity for 24 hours and may be prescribed IV medication.

Interventional radiology

During the procedure, the interventional radiologist will first clean the site where the drainage will occur. They will then use imaging techniques such as ultrasound, X-rays, or a CT scan to guide them in inserting a needle and catheter into the fluid-filled area. The skin is numbed with local anesthesia to minimize pain during the procedure.

If a large amount of fluid needs to be removed or if the fluid is too thick, a drainage tube may be inserted instead of a needle. The doctor will make a small incision and insert a thin plastic drainage tube, with the free end connected to a drainage bag. The incision is closed with a small stitch to hold the tube in place, and the area is covered with a dressing.

After the procedure, the patient will be monitored for a few hours before being discharged. They will be advised to avoid strenuous activities for 24 hours and to keep the dressing dry for a couple of days. The drainage bag will be changed as needed, and once most of the fluid has drained, the tube will be removed. This is usually done on the ward and is not a painful process.

Lower extremity oedema

The diagnosis of lower extremity oedema typically involves a thorough examination of the skin and underlying structures of the affected area. This includes assessing for signs of infection, thrombophlebitis, varicose veins, ulcerations, and skin changes such as thickening, hyperpigmentation, plaques, and nodules. Initial imaging tests such as duplex ultrasound (DUS) are often used to evaluate the extent of the swelling and identify any underlying vascular or structural abnormalities.

Treatment options for lower extremity oedema vary depending on the underlying cause and severity. Conservative management includes oral diuretics, elevation of the affected limbs, diligent skin and nail hygiene, exercise, and compressive garments or wraps. More aggressive approaches may include decongestive physiotherapy, manual lymphatic drainage massage, and intermittent pneumatic compression.

In cases of severe lower extremity oedema, particularly in hospice or palliative care settings, subcutaneous drainage has been used to improve patients' quality of life. This involves creating subcutaneous tracts in the legs to allow for the drainage of excess interstitial fluid. Needle aspiration and drainage techniques can also be used to remove fluid, with larger amounts or thicker fluids requiring drainage over a period of time using a thin plastic tube. These procedures are generally safe but may be accompanied by minor complications such as local bruising or bleeding.

Causes of fluid build-up

Fluid aspiration and drainage is a procedure to remove excess fluid that has built up in the body. This procedure is often carried out on patients with abnormal collections of fluid, such as fluid around the lung, that is causing severe symptoms.

Fluid can build up inside the body for numerous reasons. Here are some common causes of fluid retention in the legs:

Gravity

If you spend a lot of time sitting or standing in one place for too long, water is pulled down by gravity into your arms, legs, and feet, resulting in dependent edema.

Weakened Vein Valves (Venous Insufficiency)

Weak vein valves make it difficult for veins to push blood back up to the heart, leading to varicose veins and fluid accumulation in the legs.

Underlying Medical Conditions

Heart failure, lung disease, liver disease, kidney disease, thyroid disease, and certain infections are among the conditions that can cause edema as a symptom.

Side Effects of Medication

Some medications, such as those for blood pressure or pain management, can have edema as a side effect.

Poor Nutrition

A diet high in salt or a lack of proper nutrition can cause fluid retention in the body. Salt causes the body to retain water, which can then leak into the tissues and cause swelling.

Pregnancy

During pregnancy, the uterus puts pressure on the blood vessels in the lower trunk of the body, leading to swelling in the legs.

It is important to note that this list is not exhaustive, and there may be other causes of fluid build-up in the legs. If you are experiencing fluid retention or swelling, it is always best to consult with a healthcare professional for proper diagnosis and treatment.

Preventing fluid build-up

Fluid can build up inside the body for many reasons. Small amounts of fluid can be drawn off using a needle and syringe, while larger amounts or thicker liquids will need to be drained over time using a thin plastic tube. This procedure is known as fluid aspiration and drainage.

Fluid aspiration and drainage may be recommended if you have an abnormal collection of fluid, such as fluid around the lungs, causing severe symptoms. During a fluid aspiration, your doctor will insert a special needle into the fluid pocket and take a sample of the fluid to test in a laboratory for infection. In some cases, all the fluid may be removed during the initial procedure, or you may be discharged with a drainage catheter in place.

To prevent fluid from building up in your body, there are several steps you can take:

• When sitting or lying down, elevate your legs with a pillow to keep them above the level of your heart.
• Avoid sitting or standing for long periods without moving, and take short walks.
• Wear support socks, stockings, or sleeves to prevent fluids from collecting.
• Reduce salt in your diet.
• Take diuretics as directed by your doctor.

Frequently asked questions