The use of tunneled pleural catheters in the treatment of pleural effusions

Chee, Alex; Tremblay, Alain

doi:10.1097/mcp.0b013e3283463dac

Cited by 29 publications

(15 citation statements)

References 43 publications

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“…Adverse effects events associated with the indwelling catheter include pleural infection (2.8%) (which can be managed with intravenous antibiotics, leaving the catheter in place), catheter blockage (which can be managed with the instillation of a fibrinolytic into the catheter or replacement of the catheter), and chest pain with the removal of fluid (which can be minimized by draining the fluid more slowly). 44 The primary alternative to insertion of an indwelling pleural catheter is to inject an irritant into the pleural space, which can create an intense inflammatory response, leading to fusion of the visceral and parietal pleural. 1 Many different agents have been used as pleurodesing agents, but doxycycline 500 mg is the agent I recommend.…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%

Pleural Effusions

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2011

Medical Clinics of North America

214

153

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There are many diseases that cause pleural effusions. When a patient with a pleural effusion is first evaluated, one should determine if the patient has a transudate or an exudate. A diagnostic approach to the patient with an undiagnosed pleural effusion is outlined. The most common pleural effusions including those caused by congestive heart failure, cirrhosis, pneumonia, malignancy, tuberculosis, lupus erythematosus, rheumatoid disease, and chylothorax are discussed.

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Section: Malignant Pleural Effusionmentioning

confidence: 99%

Pleural Effusions

Light¹

2011

Medical Clinics of North America

214

153

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“…Spontaneous pleurodesis can develop in 40–70% of patients with IPC in situ, which permits catheter removal 5. On other occasions, the IPC may be removed due to cessation of drainage or development of serious complications such as empyema or severe pain.…”

Section: Introductionmentioning

confidence: 99%

“…It is increasingly realised that nonexpandable (or 'trapped') lungs are common in MPEs. 5 A recent study using pleural ultrasound as a screening tool found 50-60% of MPE patients had nonexpandable lungs and poor performance not suitable for talc pleurodesis. 6 IPC, however, can be used for all MPE patients whether the lung is expandable or trapped.…”

Section: Introductionmentioning

confidence: 99%

Complications of indwelling pleural catheter use and their management

2016

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The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies.

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“…It can be inserted on an outpatient basis as a day care procedure and further care is provided at home by trained healthcare professionals or by family members. However, there is a burden of on-going care such as wound dressing changes and drainages [12]. Nonetheless, according to the TIME2 trial this does not affect the quality of life in these patients [7].…”

Section: Discussionmentioning

confidence: 99%

Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

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Schmid²,

Hoksch³

2017

J Clin Trial

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Objective: In 2013 we started to combine VATS poudrage with simultaneous insertion of an indwelling pleural catheter (IPC) for management of malignant pleural effusions (MPE) to achieve successful pleurodesis, avoid recurrence of MPE and shorten hospitalization time. The aim of this study was to distinguish whether the combination treatment is superior over standard VATS poudrage. Methods:This retrospective descriptive study analyses data of patients with MPE treated at our department since the implementation of the method. The historic control group included patients with MPE treated with VATS poudrage alone.Results: There were 117 patients, 67 patients were treated with the new approach (IPC group) and 50 patients with VATS talc poudrage (control group). Both groups were comparable in demographic data. The postoperative hospitalization time was significantly shorter in the IPC group (P=0.0001). Patients in the control group got 2 chest drains inserted (Ch 24/Ch 28) and in the IPC group 1 chest drain (Ch 24) plus the IPC. Chest drains could be removed quicker in the IPC group (P=<0.0001). So far there was not a single case of unsuccessful pleurodesis with our approach compared to 10% failure rate in the control group. Conclusion:The combined approach is a safe and effective approach in MPE prophylaxis. Patients were discharged earlier and further treatment, e.g., chemotherapy, could be initiated in time.

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The use of tunneled pleural catheters in the treatment of pleural effusions

Cited by 29 publications

References 43 publications

Pleural Effusions

Pleural Effusions

Complications of indwelling pleural catheter use and their management

Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

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