P02.18 Indwelling Pleural Catheter Placement in a Large UK District General Hospital

Abstract

Indwelling pleural catheters (IPC) have become the main stay for patient centred treatment of malignant pleural effusions. They can be inserted as day case procedures, have very low complication rates and improve quality of life. They also reduce inpatient length of stay in respect to the malignant effusion. We have an established pleural service and analysed our practice over 4 years. All the notes of patients requiring IPC insertion between 2015 and 2019 were reviewed. 159 patients had an IPC inserted. 130 had died; mean survival 162 days. Mean age was 72.3 years and 39% of patients were female (n=62). 78 IPCs were done for mesothelioma, 61 done for other malignancies (29 lung, 24 breast, rest varied : melanoma, prostate cancer, ovarian cancer, colorectal cancers amongst others). 20 were done for non-malignant indications such as fibrinous pleuritis, cardiac amyloidosis, effusions of unknown cause, liver cirrhosis, heart failure. 146 IPCs were inserted as a day case, the rest were already inpatients. IPCs are done in theatre with a one off dose of prophylactic antibiotics. Complications included 4 infections (3 of pleural space by staph epidermidis and gram negative bacilli, 1 of site: site infection by staph. aureus {MSSA} – 2.5% (lower than national average in the UK), 6 blockages- 3.8 %, requiring removal (less than national average) and 2 small pneumothoraces post insertion. 1 patient had fast AF and hypotension post insertion.13 patients had loculations requiring intervention (8%- lower than national average) with intra-fibrinolytics, All of these patients had died by the time of data collection and we have stopped this practice in light of recent evidence that palliative care is more apporpriate. 57 IPCs were removed (36%- at a national average) for spontaneous pleurodesis. We provide an safe and effective indwelling pleural catheter service. Our lower rates of infection might be due to prophylactic antibiotic usage and insertion in theatre.