Use Of Pleural Catheters Research Articles

Early discharge for patients with benign pleural effusions using a Wayne catheter (pigtail) chest drain - analysis of safety, complications, and quality of life.

to assess safety, efficacy and quality of life in patients with benign pleural effusions undergong pleural drainage with Wayne pleural catheter (DW) in an outpatient setting. this is a prospective study, in which 47 patients were evaluated between July 2017 and October 2018. Patients with non-malignant pleural effusions underwent pleural drainage with clinical evolution compatible with outpatient care were included. Patients who underwent drainage due to other conditions and patients were excluded. after catheter placement, the mean length of hospital stay was 3.14 (± 3.85) days, and 21 patients (44.68%) were discharged within 24 hours. The mean time with the catheter was 12.63 (± 7.37) days. The analysis of the pleural fluid was transudate in 87.3% of cases and exudate in 12.3%. The causes of pleural effusion were heart failure (72.3%), renal failure (19.1%), liver failure (6.3%) and pneumonia (8.5%). The quality of life, analyzed according to the parameters of the questionnaire SF 36, showed low average values when compared to other studies. Analyzing each descriptor, the average was greater only in the limitation related to physical aspects. In the other descriptors, the results were similar, but smaller. the outpatient use of pleural catheters of the Wayne type (pigtail) proved to be feasible, safe and with a low associated infection rate. This is a viable option for selected patients.

ENTEROCOCCUS FAECALIS EMPYEMA AS A RARE COMPLICATION OF INDWELLING PLEURAL CATHETER USED IN THE MANAGEMENT OF CHRONIC NONMALIGNANT PLEURAL EFFUSION

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Indwelling pleural catheters (IPCs) are increasingly utilized in the symptomatic management of chronic benign and malignant pleural effusions. While they offer notable advantages in terms of improving quality of life and potentially achieving pleurodesis, IPCs have been seldom associated with the development of pleural infection. In fact, a large multicenter review evaluating 1021 patients across 11 different centers reported an infection rate of only 4.8%. Etiology is thought to be related to bacterial "colonization" of the pleural catheter; however, to date, there has been no published literature discussing the incidence or significance of bacterial colonization in IPC-treated patients. Furthermore, most bacterial species isolated from IPC-related empyemas include Staphylococcus, Pseudomonas, and Enterobacteriaceae. Herein lies the first reported case of IPC-related empyema due to Enterococcus faecalis infection. CASE PRESENTATION: An 84-year-old man with a past medical history of end-stage renal disease (ESRD) on hemodialysis, chronic heart failure with preserved ejection fraction (HFpEF), chronic respiratory failure related to poorly controlled obstructive sleep apnea (OSA) requiring 5 liters of supplemental oxygen was admitted to the medical intensive care unit for septic shock due to Enterococcus faecalis bacteremia. Patient recently had A left-sided IPC placed two weeks prior to presentation for chronic left-sided non-malignant pleural effusion. Further evaluation revealed the presence of a new, left-sided, multiloculated pleural effusion. Drainage from the IPC was purulent in nature, and fluid cultures grew Enterococcus faecalis. After allowing continued drainage from the IPC and starting appropriate antibiotic therapy, the patient improved significantly. DISCUSSION: A recent systematic review of nineteen studies evaluated 1168 patients with IPCs and determined the incidence of empyema to be only 2.8%. Despite the rarity of this complication, there are no formal guidelines for management. Several proposed therapeutic options in addition to standard antibiotic therapy have been utilized by clinicians, including instillation of intrapleural fibrinolytics or antibiotics, surgical evacuation, and removal of the IPC. Clinicians should be aware of this seldom reported manifestation, as prompt recognition and diagnosis can assist with developing an appropriate multidisciplinary approach to treatment. CONCLUSIONS: Indwelling pleural catheters (IPCs) are increasingly utilized in the symptomatic management of chronic benign and malignant pleural effusions. Although they offer several benefits in terms of increasing patient quality of life and improving symptoms, clinicians should be aware of the rare potential complications, particularly infection. Several management options are available and should be tailored to patient specific factors. REFERENCE #1: Lui MM, Thomas R, Lee YC. Complications of indwelling pleural catheter use and their management. BMJ Open Respir Res. 2016 Feb 5;3(1):e000123. doi: 10.1136/bmjresp-2015-000123. PMID: 26870384; PMCID: PMC4746457. REFERENCE #2: Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011 Jan;26(1):70-6. doi: 10.1007/s11606-010-1472-0. Epub 2010 Aug 10. PMID: 20697963; PMCID: PMC3024099. REFERENCE #3: Kniese C, Diab K, Ghabril M, Bosslet G. Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications. Chest. 2019 Feb;155(2):307-314. doi: 10.1016/j.chest.2018.07.001. Epub 2018 Jul 7. PMID: 29990479; PMCID: PMC6363815. DISCLOSURES: No relevant relationships by Mansur Assaad, source=Web Response No relevant relationships by Rajamurugan Meenakshisundaram, source=Web Response No relevant relationships by FARAZ Siddiqui, source=Web Response

Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy. A Multicenter Study.

Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy.Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS).Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS.Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015).Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.

Does attempting talc pleurodesis affect subsequent indwelling pleural catheter (IPC)-related non-draining septated pleural effusion and IPC-related spontaneous pleurodesis?

Prior talc pleurodesis does not result in worsened outcomes from subsequent indwelling pleural catheter use, and patients should not be dissuaded from choosing talc as a primary treatment for recurrent pleural effusion. http://ow.ly/qAAC30mYmr3

Tunneled pleural catheter use for pleural palliation does not increase infection rate in patients with treatment-related immunosuppression.

Concerns for infections resulting from antineoplastic therapy-associated immunosuppression may deter referral for symptom palliation with a tunneled pleural catheter (TPC) in patients with malignant/para-malignant pleural effusions (MPE/PMPE). While rates of TPC-related infections range from 1 to 21%, those in patients receiving antineoplastic therapy with correlation to immune status has not been established. We aimed to assess TPC-related infection rates in patients on antineoplastic therapy, determine relation to immune system competency, and assess impact on the patient. Patients with a MPE/PMPE undergoing TPC management associated with antineoplastic therapy, from 2008 to 2016, were reviewed and categorized into those with an immunocompromised versus immunocompetent immune status. Of the 150 patients, a TPC-related infection developed in 13 (9%): pleural space in 11 (7%) and superficial in 2 (1%). Ninety-three percent (139/150) were identified to be immunocompromised during their antineoplastic therapy. No difference in TPC-related infections was seen in patients with an immunocompromised (9%, 12/139) versus immunocompetent status (9%, 1/11); p = 0.614. The presence of a catheter-related infection did not negatively impact overall survival over a median follow-up of 144days (interquartile range 41-341); p = 0.740. These results suggest that antineoplastic therapy may not significantly increase the overall risk of TPC-related infections, as the rate remains low and comparable to rates in patients not undergoing antineoplastic therapy. Regardless of immune status, the presence of a catheter-related infection did not negatively impact overall survival. These results should reassure clinicians that the need to initiate antineoplastic therapy should not delay definitive pleural palliation with a TPC.

Indwelling Pleural Catheters for Patients with Hematologic Malignancies. A 14-Year, Single-Center Experience.

Placement of an indwelling pleural catheter is an established modality for symptom relief and pleurodesis in the treatment of malignant pleural effusion. Concerns remain regarding possible infectious complications, risk of hemorrhage, and the rate of pleurodesis with the use of pleural catheters in the treatment of hematologic malignancies. The goals of our study were: (1) to evaluate the safety and cumulative incidence of pleurodesis with indwelling pleural catheters for patients with hematologic malignancies, and (2) to evaluate overall survival of this cohort of patients with pleural effusions. We performed a retrospective review of 172 patients with a hematologic malignancy who underwent placement of an indwelling pleural catheter between September 1997 and August 2011 at the University of Texas MD Anderson Cancer Center in Houston, Texas. A competing risk model analysis was used for complications and pleurodesis. Analysis was based on each patient's first intrapleural catheter. There were 172 patients with lymphoma (58%), acute (16%) or chronic leukemia (16%), or multiple myeloma (10%). The effusions were characterized as malignant (85.5%), infectious (4.1%), volume overload (4.7%), or therapy-related (4.7%). Chylothorax was found in 20.1%. Pleural biopsies were obtained from 13 patients. The cumulative incidence of all complications was 13.6%, and the cumulative incidence of all significant catheter-related complications was 9.5%. The incidence of empyema was 2.9%, and major bleeding (requiring transfusion or intervention) was 1.7%. Thirty-day procedure-associated mortality was 0.6%. The cumulative incidence of pleurodesis at 180 days was 50%, with a median time to pleurodesis of 81 days for the entire cohort. Indwelling pleural catheters appear to be safe for patients with hematologic malignancies. Complications and the cumulative incidence of pleurodesis are comparable to those reported for patients with solid organ malignancies.

Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation.

BackgroundIndwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study’s objective is to determine if IPC insertion is safe in patients undergoing chemotherapy.MethodsWe conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications.ResultsOne hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3 %) vs 3 (4.9 %) respectively, was not statistically different (Fisher’s exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007).ConclusionsThis is the second largest retrospective case–control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.

Complications of indwelling pleural catheter use and their management

The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis,...

Effectiveness of Tunneled Pleural Catheter Placement in Patients with Malignant Pleural Effusions

Pleural effusions (PE) occur frequently among patients with various types of advanced malignancies, resulting in remarkably decreased quality of life. Treatment of malignant PE includes placement of a chest tube with subsequent placement of a tunneled pleural catheter. We reviewed our experience with tunneled pleural catheter use to assess outcomes and resource utilization of this intervention. A retrospective study of consecutive patients (n = 163, including 41 outpatients) who were treated between July 2001 and April 2008 with tunneled pleural catheters was performed to evaluate operative and discharge outcomes. The average age of the patients was 59.32 years (range: 24 to 89). Lung cancer, breast cancer, and ovarian cancer were common primary diseases in this patient population. The mean hospital stay after tunneled pleural catheter placement was 3.19 days (range: 0 to 56), with 41 patients treated as outpatients. Thirteen inpatient deaths were related to the patients' primary diseases, but no deaths were due to drain placement itself. Eight patients (4.91%) required reoperation to replace a nonfunctioning drain or to add an additional drain, and six patients underwent a second procedure to place a contralateral drain. One hundred twenty-six patients (77.30%) were discharged home following the procedure and hospital stay. Fifty-five people achieved spontaneous pleurodesis. Tunneled pleural catheter placement is a safe and effective approach to the treatment of PE. The advantages of tunneled pleural catheter placement include symptomatic relief and improved quality of life. This method allows patients to spend time at home with their family and avoid prolonged hospitalization.