Initial Experiences with a Long-term Indwelling Tunnelled Pleural Catheter for the Management of Malignant Pleural Effusion: Technical Report

doi:10.1053/crad.2000.0555

Clinical Radiology

Volume 55, Issue 11, November 2000, Pages 882-884

https://doi.org/10.1053/crad.2000.0555 Get rights and content

Abstract

Smart, J. J. and Tung, K. T. (2000). Clinical Radiology55, 882–884.

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Cited by (12)

Use of Indwelling Pleural Catheter in the Outpatient Management of Recurrent Malignant Pleural Effusion
2009, Archivos de Bronconeumologia
El objetivo del estudio ha sido analizar la eficacia y seguridad del catéter de drenaje pleural permanente en el manejo de pacientes con diagnóstico de derrame pleural maligno.
Se ha realizado un estudio prospectivo y multicéntrico de 63 pacientes consecutivos de 4 hospitales españoles. Se incluyó a 43 varones y 20 mujeres, con una mediana de edad de 67 años, diagnosticados de derrame pleural maligno sintomático. En 7 casos el tratamiento se indicó tras fracaso de pleurodesis, en 5 por encontrarse el pulmón atrapado, en otros 5 tras toracocentesis repetidas y en el resto como indicación preferente a la pleurodesis. A todos los pacientes se les insertó de forma ambulatoria un catéter tunelizado permanente (PleurX^®, Denver Biomedical).
La mayoría de los pacientes (95,4%) refirió mejoría parcial o completa de los síntomas respiratorios (tos y disnea) y de su capacidad funcional. La mediana de duración de uso del catéter fue de 45 días (rango: 6–222). La mediana diaria de líquido pleural drenado fue de 75 ml. En 22 casos (34,9%) se produjo una pleurodesis espontánea. No se registraron complicaciones durante la inserción del catéter. Las complicaciones durante el seguimiento fueron las siguientes: empiema (3 casos), dolor torácico (2 casos) y diseminaciones del tumor por el lugar de inserción del tubo (3 casos).
El catéter de drenaje pleural permanente es eficaz en el manejo ambulatorio del paciente con derrame pleural maligno sintomático. Es un procedimiento sencillo que no precisa ingreso hospitalario, de fácil manejo para el paciente en su domicilio y con escasas complicaciones.
To analyse the effectiveness and safety of the indwelling pleural catheter in the management of recurrent malignant pleural effusion.
A prospective multicentre study was performed in 63 consecutive outpatients from four Spanish hospitals. A total of 43 men and 20 women were included, with a median age of 67 years. In seven of the cases treatment with pleurodesis had failed; in five other cases their lung was trapped; in another five cases after repeat therapeutic thoracocentesis, and the rest of them as a preference choice to pleurodesis. All patients had an indwelling pleural catheter inserted (PleurX^®, Denver Biomedical).
Most of patients (94.5%) reported an improvement in their respiratory symptoms (cough and dyspnoea) and their ability to function independently. Average length of the catheterisation was 45 days (6–222). Average amount of drained pleural effusion was 75 ml, with a frequency of drainage of between 3 and 4 times per week and once fortnightly. Spontaneous pleurodesis was achieved following 34.9% of procedures. No complications occurred during the insertion of the catheter. The post-catheterisation complications were empyema (3 cases), chest pain (2 cases), and tumour metastasis (3 cases).
The use of an indwelling pleural catheter is an effective palliative treatment in the outpatient management for patients suffering malignant pleural effusion. It is also a simple treatment that can be easily applied, does not require hospitalisation and can be easily managed by the patient at home, with a low rate of complications.
Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)
2007, Chest
Citation Excerpt :
Since the recurrence rate at 1 month after fluid drainage alone is close to 100%, chest tube drainage without pleurodesis is not recommended.8 One of the options is to place a smaller tunneled long-term pleural drainage catheter to drain the fluid on a long-term basis.261–267 This technique is effective in controlling recurrent and symptomatic malignant effusions in selected patents.
To review the scientific evidence on symptoms and specific complications that are associated with lung cancer, and the methods available to palliate those symptoms and complications.
MEDLINE literature review (through March 2006) for all studies published in the English language, including case series and case reports, since 1966 using the following medical subject heading terms: bone metastases; brain metastases; cough; dyspnea; electrocautery; hemoptysis; interventional bronchoscopy; laser; pain management; pleural effusions; spinal cord metastases; superior vena cava syndrome; and tracheoesophageal fistula.
Pulmonary symptoms that may require palliation in patients who have lung cancer include those caused by the primary cancer itself (dyspnea, wheezing, cough, hemoptysis, chest pain), or locoregional metastases within the thorax (superior vena cava syndrome, tracheoesophageal fistula, pleural effusions, ribs, and pleura). Respiratory symptoms can also result from complications of lung cancer treatment or from comorbid conditions. Constitutional symptoms are common and require attention and care. Symptoms referable to distant extrathoracic metastases to bone, brain, spinal cord, and liver pose additional problems that require a specific response for optimal symptom control. There are excellent scientific data regarding the management of many of these issues, with lesser evidence from case series or expert opinion on other aspects of providing palliative care for lung cancer patients.
Palliation of symptoms and complications in lung cancer patients is possible, and physicians who provide such care must be knowledgeable about these issues.
Imaging of Pleural Disease
2006, Clinics in Chest Medicine
Single-center experience with 250 tunnelled pleural catherer insertions for malignant pleural effusion
2006, Chest
Citation Excerpt :
The use of TPCs in the management of patients with MPE has previously been reported.45691011122021 This approach offers several key benefits over previous approaches, in particular more liberal patient selection including patients with trapped lungs,22 outpatient placement and management without sedation or general anesthesia,4568910111223 rapid and persistent symptomatic improvement,12 cost-effectiveness,10 and low complication rates.9101224 Our experience with a large number of TPC procedures for the treatment of MPE adds to the published experience with this new technique and allows more accurate descriptions of outcomes and complication rates.
Malignant pleural effusions (MPEs) are a common cause of dyspnea in patients with advanced cancer. Tunnelled pleural catheters (TPCs) can be used in patients with this condition, but the published experience with them is limited.
To describe the use of TPCs in the management of MPE in a large group of patients in a clinical setting.
Retrospective analysis of 250 sequential TPC insertions in patients with MPEs in a single center.
Two hundred fifty TPC procedures for MPE were performed in 223 patients (19 contralateral procedures and 8 repeat ipsilateral procedures) during a 3-year period. Symptom control was complete following 97 procedures (38.8%), was partial in 125 procedures (50%), and was absent in 9 procedures (3.6%); in addition, there were 10 failed TPC insertions (4.0%) and 9 TPC insertions (3.6%) without assessment of symptoms at the 2-week follow-up visit. Spontaneous pleurodesis occurred following 103 of the 240 successful TPC procedures (42.9%) and was more frequent when ≤ 20% of the hemithorax contained fluid at the 2-week follow-up visit (57.2% vs 25.3%, respectively; p < 0.001). Catheters stayed in place for a median duration of 56 days. Following successful TPC placement, no further ipsilateral pleural procedures were required in 90.1% of cases. The overall median survival time following TPC insertion was 144 days. Complication rates were low and compared favorably with those seen with other treatment options.
TPC placement is an effective method of palliation for MPE that allows outpatient management and low complication rates. The insertion of a TPC should be considered as a first-line treatment option in the management of patients with MPE.
Surgical palliation of thoracic malignancies
2004, Surgical Oncology Clinics of North America
Malignant pleural effusions
2002, Surgical Clinics of North America

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RAInitial Experiences with a Long-term Indwelling Tunnelled Pleural Catheter for the Management of Malignant Pleural Effusion: Technical Report

Abstract

Clin Radiol

Ann Thorac Surg

Chest

RA
Initial Experiences with a Long-term Indwelling Tunnelled Pleural Catheter for the Management of Malignant Pleural Effusion: Technical Report