Management of non-ovarian cancer malignant ascites through indwelling catheter drainage

Gu, Xihui; Zhang, Yuanyuan; Cheng, Menglei; Liu, Minghui; Zhang, Zhe; Cheng, Wenwu

doi:10.1186/s12904-016-0116-5

Cited by 11 publications

(14 citation statements)

References 46 publications

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“…These were managed using local procedures such as additional sutures, use of a bag to collect the fluid if leakage occurred, and catheter replacement. 26 – 28 CVCs are rather ineffective in patients with mucinous ascites. 27 Patients reported alleviation of all the ascites-related symptoms after drainage by CVC compared with baseline, with abdominal swelling, anorexia, and constipation being the most significantly changed (the severity of the symptoms was assessed using a linear scale).…”

Section: Resultsmentioning

confidence: 97%

“…Mechanical problems were the main issue, and included leakage, catheter dislodgment, or “not working”. These were managed using local procedures such as additional sutures, use of a bag to collect the fluid if leakage occurred, and catheter replacement 26–28. CVCs are rather ineffective in patients with mucinous ascites 27.…”

Section: Resultsmentioning

confidence: 99%

“…CVCs are rather ineffective in patients with mucinous ascites 27. Patients reported alleviation of all the ascites-related symptoms after drainage by CVC compared with baseline, with abdominal swelling, anorexia, and constipation being the most significantly changed (the severity of the symptoms was assessed using a linear scale) 28. In another study, it was the impression of the health care team that patients were very comfortable following CVC placement and reported better symptom control and an increased intake of food and nutritional supplements 27…”

Section: Resultsmentioning

confidence: 99%

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Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297) of patients experienced any complication and 6.2% (81/1297) experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed. Deterioration was observed in cognitive and emotional subscales. MA drainage is a safe and effective method to control symptoms associated with ascites, and should be perceived as a supportive care, that can be applied for those who need it at any time of their cancer trajectory. Patient selection should be performed using a thorough assessment of symptoms and QOL, and should not be delayed.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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“…The rate of technical success of indwelling catheters insertion was reported to be 100% and the rate of symptom control was 75% to 100% (3,4). A significant improvement in symptom control and quality of life has also been reported in almost all patients (3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(14). In light of these favorable clinical outcomes, insertion of indwelling abdominal drains appears to be a promising option for relieving refractory ascites in patients with advanced malignancy.…”

Section: Indwelling Abdominal Drain For Intermittent Drainagementioning

confidence: 99%

“…Although the technical safety and clinical efficacy of indwelling abdominal drains for advanced cancer patients with refractory ascites have been demonstrated (3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), bacterial colonization and subsequent drain-related infection remain to be common concerns for these types of long-term drains inserted into the peritoneal cavity as in patients with other types of long-term indwelling catheters, for example, Tenckhoff catheters (26), central venous access (27)(28)(29) and urinary catheters (30). Colonization of these catheters can lead to resistance to antibiotic treatment because of the formation of bacterial biofilm (31)(32)(33).…”

Section: Bacterial Colonization and Drain-related Infectionmentioning

confidence: 99%

Patterns and infection outcomes of bacterial colonization in patients with indwelling abdominal drains for malignant ascites

Chan¹,

Cheung²,

Chan³

et al. 2020

Ann Palliat Med

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Background: Indwelling abdominal drains for intermittent drainage is an effective treatment for refractory malignant ascites, bacterial colonization and subsequent drain-related infection is however a common concern. This study aimed to investigate the patterns of bacterial colonization and the subsequent infection outcomes in patients with indwelling abdominal drains. Methods: All consecutive advanced cancer patients with newly inserted indwelling abdominal drains and who were under the service of the ascites clinic of our institution for intermittent drainage between January 2011 and March 2018 were screened for study eligibility. Patients with positive surveillance ascitic fluid culture without immediate drain-related infection were included in the final analysis. Clinical information during the drainage period was prospectively collected using standardized clinical assessment forms. These assessment forms and other medical records were retrospectively reviewed. Results: Sixty nine patients developed bacterial colonization without immediate infection during the study period. The most common cancer diagnosis was hepatocellular carcinoma (HCC), which comprise 30.4% of the population. Central venous catheters (CVCs) were inserted in 76.8% of patients and pigtail drains in 23.2% as the indwelling abdominal drain. The median duration from drain insertion to the development of bacterial colonization was 18.0 days. Staphylococci, Diphtheroid bacilli and Enterococci were the most common types of bacteria isolated during colonization. Thirty patients (43.5%) developed drain-related infection subsequently and the median time from bacterial colonization to development of infection was 14.5 days.The incidence rate of drain-related infection after bacterial colonization was 1.78 per 100-catheter days and the 1-month infection-free survival was 54.4%. Five patients (7.2%) developed peritonitis and 4 of them died from the infection episode. Decrease in body mass index (BMI) (P=0.03), having 3 or more episodes of drainage in the ascites clinic before bacterial colonization (P=0.03), presence of Escherichia coli (P=0.04) and Bacillus species (P=0.04) in surveillance ascitic fluid culture were significantly correlating with infection outcomes in univariate analyses. HCC as cancer diagnosis (OR 8.85, 95% CI: 1.86-42.07, P=0.006) and decrease in body weight (OR 1.20, 95% CI: 1.02-1.42, P=0.03) were significant factors that correlated with infection outcomes in multivariate analysis. Conclusions: Bacterial colonization and subsequent progression into drain-related infection are common in patients on indwelling abdominal drains for malignant ascites. Staphylococci is the most common type of bacteria causing both colonization and subsequent drain-related infection. HCC and decrease in body weight are significant factors that correlate with infection outcomes after bacterial colonization.

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