Prospective Evaluation of the PleurX Catheter When Used to Treat Recurrent Ascites Associated with Malignancy

Courtney, Angi; Nemcek, Albert A.; Rosenberg, Stefanie M.; Tutton, Sean; Darcy, Michael; Gordon, Greg

doi:10.1016/j.jvir.2008.09.002

Cited by 60 publications

(78 citation statements)

References 17 publications

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“…This compares well with the only other study to evaluate a similar number of patients with tunnelled peritoneal drains (85% patency at the time of death [6]). Furthermore, these authors emphasise that the protocol-specified objective performance criteria for drain patency is 35 days, and their results were superior with the lower limit of the 95% confidence interval at 86 days patency.…”

Section: Discussionsupporting

confidence: 77%

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PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

Tapping¹,

Ling²,

Razack³

2012

BJR

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Objectives: The aim of this article was to assess the success, safety, complication profile and factors associated with long-term patency of tunnelled peritoneal drains (PleurX) in the treatment of refractory malignant ascites. Methods: Over a 4-year period, 28 consecutive patients (32 drain insertions) with refractory malignant ascites were treated with a PleurX drain. The study group comprised 7 males and 21 females (mean age, 61 years). A combination of fluoroscopic and ultrasound guidance was used to insert 4 drains; the remaining 28 drains were inserted under ultrasound guidance alone. Patient history, biochemical profiles, pathological and procedural records and clinical follow-up until death were reviewed. Statistical analysis included multivariate logistic regression analysis and Kaplan-Meier curves (p,0.05 was considered significant).Results: There was a 100% technical success rate for the insertion of the drain; there were no procedure-related deaths and no major complications. Only minor complications were reported: three (10%) immediate; three (10%) early; and two (7%) late. Factors significantly associated with these complications included current chemotherapy, low haemoglobin levels, low albumin levels, high white cell count and high c-reactive protein levels. The length of time the drains remained in situ, and therefore patent, ranged from 5 to 365 days (mean, 113 days). Out of the original 28 tunnelled drains, 24 (86%) remained in situ and functioning until the patients' death. Four (14%) drains dislodged and a subsequent PleurX drain was inserted on the opposite side of the abdominal wall. These new drains remained patent until the patient's death. The annual event rate was 0.45 events per year. A comorbid diagnosis of renal disease or chemotherapy was significantly related to a decreased length of patency. Conclusion: The use of tunnelled peritoneal drains is safe and effective and we would advocate their use as a first-line approach in patients with refractory malignant ascites. Care and regular follow-up is indicated following insertion of the drain in all patients, especially those on chemotherapy and those with a pre-procedure diagnosis of renal disease.

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Section: Discussionsupporting

confidence: 77%

“…Various studies have found that the PleurX catheter is an effective option for the management of malignant ascites with a low complication rate [5][6][7]. The PleurX drain is a tunnelled indwelling peritoneal catheter that can be managed at home to remove small (500 ml) aliquots of ascites on a regular basis or when it becomes symptomatic.…”

mentioning

confidence: 99%

PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

Tapping¹,

Ling²,

Razack³

2012

BJR

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“…8 In a report of their experience with 10 patients, Richard and colleagues did not report any catheter-related infections but had two catheters removed as they were no longer needed, one was pulled out by a patient but was not replaced and one catheter was treated with tissue plasminogen activator (TPA) to unclog it. 12 In a prospective, multicenter clinical trial by Courtney and coworkers 14 of 34 patients with recurrent malignant ascites, technical success of placement was 100%. Four patients required multiple interventions to unclog the catheter ranging from tPA administration to wire manipulation to maintain patency.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] The PleurX catheter system has also been shown to reduce the need for frequent hospital visits for percutaneous drainage, with an overall per-patient complication rate similar to that of paracentesis. 8 This study describes the implantation success rate, short-term fluid drainage, procedural complications, and adverse events among patients with malignant ascites who underwent PleurX catheter system placement at a single institution.…”

mentioning

confidence: 99%

Safety and Efficacy of the PleurX Catheter for the Treatment of Malignant Ascites

Narayanan

Pezeshkmehr

Venkat

et al. 2014

Journal of Palliative Medicine

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Background: Malignant ascites is a common complication seen in association with various types of neoplastic processes. Due to high recurrence rates, patients may require multiple paracenteses, which have associated complications such as increased risk of bleeding, infection, pain, and volume and electrolyte depletion. Objective: This study evaluated the management of malignant ascites by placement of the PleurXÒ tunneled catheter system at a single center. Methods: This was a retrospective study of 38 patients who underwent PleurX catheter placement for refractory malignant ascites between February 2006 and March 2012 at our institution. Pretreatment characteristics and outcome measures were reported using descriptive statistics. Results: The population included 21 males and 17 females with a mean age of 60.6 years (range, 36-79 years) diagnosed with metastatic disease from a variety of primary malignancies, the most common of which was pancreatic cancer (10 patients). In 84% of patients (32/38) who were not lost to follow-up, mean survival time was 40.7 days (range 4-434 days). Technical success rate of catheter placement was 100%. Conclusions: The PleurX catheter can be used to manage malignant ascites in severely ill patients with metastatic cancer, with a high rate of procedural success and a low incidence of potentially serious adverse events, infections, or catheter-related complications.

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“…Dies führt oft zu iatrogenen, peritonealen Entzündungen mit nachfolgender Non-Compliance der Patienten. Nicht zu vernachlässigen ist die Tatsache, dass Tumorzellen in die Bauchhöhle ausgeschwemmt werden und so peritoneale Fernmetastasen bilden können, was wiederum in weiterer Folge zu Aszitesbildung führen kann [6,9,13]. Die Thorakoskopie ist der Goldstandard, um Pleuraergüsse unklarer Ätiologie zu untersuchen.…”

Section: Introductionunclassified

Nutzen und Sicherheit der Behandlung von Pleuraergüssen mit dem PleurX-Katheter: eine retrospektive Analyse

Blaukovitsch

Strassburg²,

Müller³

et al. 2011

Pneumologie

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! Background:The purpose of this retrospective study was to investigate the efficacy and safety of an indwelling pleural device (PleurX, Denver Biomedical, USA) for the treatment of recurrent pleural effusions. In cases when life expectancy tends to be very short and also surgical decortication is not recommended, pleurodesis is another treatment option but requires complete drainage of the whole pleural fluid for optimal results which is sometimes hard to achieve. The PleurX catheter is an alternative therapeutic option. Methods and Results: We retrospectively analysed the clinical data from a total of 21 patients who were treated with a PleurX alone (11 patients) or who initially received pleurodesis and afterwards a PleurX catheter (10 patients). Mean survival was 25 weeks after initial diagnosis of the underlying disease. The mean amount of pleural effusion drained per week was 725 mL. 16 patients used the catheter until they died at least 1 -2 times a week. The complication rate was 19 % and thus within a reasonable range when compared to other treatment options for recurrent pleural effusions. There was no statistically significant difference in clinical outcome in both groups (pleurodesis and subsequent PleurX vs. PleurX alone). The amount of evacuated pleural effusion was inversely correlated with the remaining life time. Conclusion: The use of an indwelling pleural device is a safe alternative treatment option for patients with chronic pleural effusions and trapped lung signs. We should be aware of this device and propagate its use at an earlier stage of malignant diseases with recurrent pleural effusions, especially when the remaining life time is short.

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Prospective Evaluation of the PleurX Catheter When Used to Treat Recurrent Ascites Associated with Malignancy

Cited by 60 publications

References 17 publications

PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

Safety and Efficacy of the PleurX Catheter for the Treatment of Malignant Ascites

Nutzen und Sicherheit der Behandlung von Pleuraergüssen mit dem PleurX-Katheter: eine retrospektive Analyse

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