Indwelling pleural catheters: complications and management strategies

Abstract

Indwelling pleural catheters (IPCs) are increasingly being used for patients with recurrent malignant pleural effusions. They are simple to place and can be done on an outpatient basis under local anesthesia. IPCs uniformly relieve dyspnea and improve quality of life of patients with malignant pleural effusions. In some patients with recurrent non-malignant pleural effusions, IPCs proved to be effective as well. With increasing use of IPCs, physicians and patients are faced with complications related to the presence of an indwelling catheter for extended periods of time. The purpose of this review is to describe the various complications of IPCs and to present the available data on how to best treat and potentially prevent these complications.

Indwelling pleural catheters for malignancy related pleural effusions

“…12 IPC-related infection of the chest wall and/or pleural space traditionally affects less than 5% of patients and our case series corroborates this evidence. There is no signi cant increase in risk of IPC-related infection associated with systemic chemotherapy 8,10,11 , as 128 patients in our series received chemotherapy. Infections are traditionally associated with skin commensals and staph aureus species, as was the case here, and the removal of the IPC is not usually warranted, unless the tunnel is chronically infected, as was the case in one patient in our case series.…”

“…Our overall complication rate was 13%, and individual rates are lower than previously described. 9,10,11 Only speci c pleural physicians with signi cant cumulative experience place IPCs locally, and any training doctors are closely supervised. National safety standards for invasive procedures (NATSIP) checklists are rigidly adhered to and the use of thoracic ultrasound allows the correct identi cation of a suitable pleural space.…”

High‐pressure leakage of pleural fluid through the healed entry site of the indwelling pleural catheter from undrained locules

“…Persistent fluid leakage through the IPC entry site shortly after insertion has been reported [3,4]. It is due to the high intrapleural pressure from the undrained pleural effusion, which can be avoided by drainage prior to and immediately after the insertion procedure [3]. To the best of our knowledge, leakage along the IPC insertion tract and rupture through the healed entry site has never been reported.…”

“…The indwelling pleural catheter (IPC) is an established treatment for MPE to minimize the need for repeated pleural intervention. However, its drainage effectiveness can be limited by fluid loculation [1], and various complications may happen after placement, including fluid leakage, wound infection, and catheter tract metastasis (CTM) [2–4]. We report a case of fluid leakage through the healed entry site of IPC due to high intrapleural pressure built inside an undrained pleural fluid locule, which mimics wound infection and CTM.…”

Komplikationen nach pleuralem getunnelten Dauerkatheter bei symptomatischen rezidivierenden benignen und malignen Pleuraergüssen

“…Auftreten und Ausdehnung des Pneumothorax zeigten keinen Zusammenhang mit der Ergussdignität (p = 0,946), der Grunderkrankung (p = 0,688) und dem Operateur (n = 8; p = 0,497 [9 -19]. Der Anteil einer Katheterinfektion wird in gemischten Gruppen mit MPE und BPE in 3 retrospektiven Untersuchungen mit 1,3 -5,3 % [11,12,24], bei MPE in einer prospektiven und 4 retrospektiven Analysen mit 2,5 -9,6 % [10,14,16,17,20] sowie bei BPE in einem Review und 3 retrospektiven Studien mit 2,3 -16,1 % beschrieben [13,15,18,19]. Bemerkenswert ist eine in etwa gleich große deutschsprachige Untersuchung von Dilkaute et al an 69 Patienten [24].…”