Tunneled Pleural Catheters for Management of Malignant Pleural Effusions: A Two-Year Review of Outcomes From a High Volume Center

Abstract

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Tunneled pleural catheters (TPC) have become a mainstay in the management of malignant pleural effusions. Our center has placed 66 TPCs for management of malignant pleural effusions. This paper reports our experience over the past 16 months as a high volume center for placement of TPCs. METHODS: Patients who received a TPC at our center between September 2014 and January 2016 were included. Patients were followed through March 2016 and monitored for length of time between placement of catheter and pleurodesis, complications, need for intrapleural fibrinolytic therapy, and overall survival rate. RESULTS: Sixty-six (66) tunneled pleural catheters were placed in the 16 month period. The majority of patients had lung cancer (47%) or breast cancer (15%). In our series, autopleurodesis is defined as adhesion of the lung to the chest wall as demonstrated by ultrasound and less than 50ccs of drainage from the catheter per day. Autopleurodesis leading to the ability to remove the TPC was achieved in a median of 49 days. Only two catheters required replacement for recurrent effusion and one of these was after the initial tube was removed due to patient request. Forty-five percent of patients (30/66) did not achieve autopleurodesis and continued to drain for symptomatic relief until death, which was an average of 70 days after TPC placement. 10% percent of patients (7/66) required intrapleural thrombolytic therapy for loculated pleural effusions without any bleeding complications. Only one major complication was observed in the form of an inadvertantly dislodged catheter unrecognized by the patient until becoming febrile due to a then discovered empyema. Minor complications involved two of the polyester cuffs separating from the catheter during TPC removal resulting in the cuff remaining subcutaneously in the chest wall. Overall, 96% of patients who received a TPC had no complications. CONCLUSIONS: A TPC is a safe and effective method of treating recurrent malignant pleural effusions. CLINICAL IMPLICATIONS: In patients with TPC placement, there is a 60% occurrence of autopleurodesis at 8 weeks. As long as the patient understands home care of the catheter, there is minimal risk of complication from long term use of a TPC for management of malignant pleural effusion. DISCLOSURE: The following authors have nothing to disclose: Christiana Powers, Sandeep Khandhar, Amit Mahajan No Product/Research Disclosure Information