P70 Talc slurry pleurodesis: does mixing talc with 50% dextrose rather than normal saline increase success rate?

Abstract

Introduction Symptomatic malignant pleural effusions can be managed effectively with talc pleurodesis. Various studies document the success rate for talc pleurodesis around 80%. In these studies, talc was mixed with normal saline to make the slurry prior to pleurodesis. We audited the success rate for pleurodesis in our hospital using slurry made by mixing talc with normal saline and slurry made by mixing talc with 50% dextrose to see if changing the ‘solvent’ made any difference to the success of the procedure. The hypothesis that 50% dextrose, being ‘stickier’ than normal saline, will achieve a better success rate was thus tested. Method In group 1, 28 patients underwent pleurodesis using slurry obtained by mixing talc with normal saline. The findings were presented to BTS in 2008. Subsequently we re-audited our practice with group 2, in which 18 patients were pleurodesied using slurry obtained by mixing talc with 50% dextrose. Results Procedure success was defined as absence of fluid reaccmulation requiring intervention at 3 months post pleurodesis. The success rate for the first group was 34% while the success rate for the second group was 76%. The second group underwent more rigorous protocol ensuring drain clamping for 1-h post procedure and use of suction in 100% compared to 80% and 87.5% in the first group. However, subgroup analysis of the first group did not reveal a statistically significant difference in success rate for these variables. Use of NSAID analgesia for 28% patients in group 1 compared to none in group 2 could have influenced the results significantly. Lastly, better patient selection and operator bias might have resulted in better success rate in the second group as recommendations from first audit were implemented in second cycle. Overall best success rate of 76% was inferior to that reported in previous studies due to more liberal patient selection. Conclusions Use of 50% dextrose rather than normal saline to mix talc for talc slurry with strict patient selection and a rigorous pleurodesis protocol as recommended by BTS guidelines can result in better success rate. This is possibly because of the resulting stickier inert slurry. However, research with a randomised control trial is required to assess this question further.