Efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of malignant pleural effusions

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19575 Background: Small-bore chest tubes are now recognized as a safe and effective alternative to large-bore catheter chest tubes for the treatment of malignant pleural effusions (MPEs). The Ottawa Hospital (TOH) developed protocols for insertion and pleurodesis to maximize efficiency and minimize complications. Objective: To evaluate the efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of MPEs. Methods: Retrospective chart review of TOH medical oncology inpatients treated for a MPE using our small-bore chest tube insertion and pleurodesis protocols from February 2003 to May 2004. Outcomes reviewed included deviations from protocol (major and minor), proportion of patients proceeding to pleurodesis and efficacy at six weeks, complications, as well as length of hospital stay. Results: One-hundred and fourteen potential cases were identified, of those 78 small-bore chest tubes were inserted into 72 patients. Major deviations from the chest tube protocol occurred in 21 patients (27%) who lacked microbiological analysis of their pleural fluid. Major complications of tube insertion occurred in ten patients (13%) who developed pulmonary infections and two patients (2.5%) who developed a significant pneumothorax. Of the 78 tube insertions, 24 cases went on to pleurodesis. Major deviations from our pleurodesis protocol occurred in five patients (2.1%) who failed to have a chest xray twenty-four hours prior to pleurodesis. The most common complication post pleurodesis was pain with seven of 24 patients (29%) rating their pain as severe. Fifteen of the 24 patients (63%) had fluid reaccumulation within six-weeks post pleurodesis. Median length of stay for patients without pleurodesis versus those with pleurodesis was 14.5 and 16.0 days, respectively. Conclusions: Our preliminary data suggests that chest tube insertion and pleurodesis protocols have good compliance rates with low rates of complications. Only a minority of patients were able to proceed to pleurodesis and long term control of effusion occurs in less than half of patients in this subgroup. As well, pain control at the time of pleurodesis was not adequate in one third of patients with the current protocol. No significant financial relationships to disclose.