Does talc increase risk of non-draining septated pleural effusion after indwelling pleural catheter insertion?

Abstract

Non-draining septated pleural effusions limit effective drainage via indwelling pleural catheters (IPC). Aim: To retrospectively analyse whether previous talc pleurodesis attempt increases chances of a non-draining septated pleural effusion after IPC insertion. Method IPC outcomes and complications for IPC insertions were analysed. ‘MPE group’ were IPC insertions for malignant pleural effusion(MPE), ‘non-MPE group’ were IPC insertions for hepatic hydrothorax(3% overall), benign pleuritis(3%), heart failure(2%), other(2.5%). Mesothelioma cases were analysed separately in view of the possibility of increased pleural tumour-induced fibrin deposition within the pleural space. Results: 202 IPC insertions were analysed: MPE group(n=181), mean age 68 years(SD 13.9), 48% female (n=87); non-MPE group(n=21), mean age 70 years(SD 10.8) (p=0.4), 29%(n=6) female (p=0.09). Overall, 2.7% (n=2) and 4.7% (n=6) of patients with and without prior talc respectively developed non-draining septated pleural effusion (p=0.47). Of these, 2(25%) patients had heterogeneously septated pleural effusion at IPC insertion, and they had not received prior talc, 75%(n=6) developed septation while IPC was in situ. Conclusion: There was no significant difference in rates of non-draining septated effusions between patients who had received prior talc and those who had not, although limited by the retrospective study design and small numbers.