Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study

Abstract

The aim of this prospective, randomized study was to investigate the possibility of performing pleurodesis using a small percutaneous catheter (Cystofix catheter, CH10, 65 cm) inserted at bedside in patients with recurrent malignant pleural effusion and to compare this catheter with a conventional large bore chest tube (CH24) placed in connection with diagnostic thoracoscopy. After drainage pleurodesis was performed with tetracycline as sclerosing agent. Of 18 evaluable consecutive patients (mean age 67.8 years) nine were randomized for pleurodesis with the small and nine for the large catheter. In the former group, the majority (seven of nine) did not find insertion of the catheter more unpleasant than thoracentesis. In the latter group only a few (two of nine) found insertion comparable with thoracentesis (P < 0.05). All patients found the presence of the large catheter very or somewhat unpleasant (two and seven patients), whereas this was only the case for a few (no and two patients) treated with the small catheter (P < 0.05). In the former group three patients required new thoracentesis, whereas this was only the case for two patients in the latter group (P > 0.05). No complications were seen. We conclude that pleurodesis in patients with recurrent malignant pleural effusion can be performed with a small percutaneous catheter (Cystofix) with an effect similar to that obtained with a large-bore chest tube and with less discomfort for the patient.

Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better?

“…The pain brought by chest tube drainage was reckoned the biggest weakness and most of the patients experienced short-lasting but intense pain when the chest tube drainage was removed (60). Some trials found small-bore chest tube drainages had the similar success rate to larger drainage but being less painful (61). To manage the inevitable pain, one of the most common complications of chest tube drainage insertion, we needed more details to notice and perform.…”

When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters

“…In fact, several recent studies support the concept that LBCTs are directly associated with higher thoracic pain (14)(15)(16)(17). Moreover, the risk of infection appears to be higher when a large-bore drain is used, especially for prolonged placements (18).…”

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

“…They found that these small-caliber catheters had a performance similar to large-caliber tubes, but with substantially reduced pain levels. The advantages of small-caliber catheters have subsequently been confirmed in numerous studies (Grodzin and Balk, 1997;Clementsen et al, 1998;Putnam et al, 2000;Parulekar et al, 2001) and the British Thoracic Society (BTS) guidelines for the management of malignant pleural effusions (Antunes et al, 2003) recommend the use of small-caliber catheters in lieu of larger-caliber chest tubes.…”