Vacuum Drainage Research Articles

Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications. Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects. Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result. Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

LOSS OF DRAINAGE VACUUM AFTER MINIMAL INVASIVE SUBLAY OPERATION – EARLY INDICATOR FOR AN INTERPARIETAL HERNIA WITH SMALL BOWEL OBSTRUCTION – A CASE REPORT

Abstract Background Newer repair techniques for abdominal wall hernias, such as the enchanced-view totally extraperitoneal technique or the mini- or less-open sublay operation are increasingly being used. With these new techniques special complications might occur. Case Report We present an 81-year-old patient with a recurrent ventral incisional hernia after IPOM repair. The preoperative abdominal CT scan showed the hernia defect, measuring 3 × 3 cm. A repair was performed in MILOS technique, the IPOM mesh was removed. The posterior the rectus sheath was closed under slight tension. A Mesh 15 × 15 cm without fixation and a 14 french Redon drainage were inserted. Over the next 4 postoperative days the drainage had a repeatedly loos of vacuum, until the patient developed clinical symptoms of a ileus. A CT scan showed a bowel dysfunction without a clear sign for incarceration. At this point, the suction drainage was without vacuum a total of seven times. A diagnostic laparoscopy was performed and a small bowel loop was found trapped between the implanted mesh and the posterior rectus sheath, as an interparietal retro-rectus hernia (iRRH). The intestinal loop could be removed, no necrosis or ischemia was found. The fascial defect was covered using vicryl mesh patch. Conclusion The role of vacuum drainage remains to be considered. Suction of remaining intraabdominal gas might occur due to fascia dehiscence and CT diagnostics can mislead surgeons decisions. Tension free fascial closure remains of capital importance. Mesh fixation, use of special stitching techniques, transversus-abdominis-release or preoperative application of botulinum toxin should be kept mind.

Pott's puffy tumor of the upper eyelid misdiagnosed as simple abscess: a case report and literature review.

A 76-year-old woman, initially thought to have a simple abscess on her right upper eyelid, presented to our department of plastic and reconstructive surgery. Enhanced three-dimensional facial computed tomography (CT) revealed an abscess on the right upper lid, with a pyomucocele present in the right frontal sinus, accompanied by bone erosion in the superior wall of the right orbit. Based on the results of the CT scan, we diagnosed an atypical Pott's puffy tumor (PPT) with an abscess on the upper lid originating from the frontal sinusitis. First, surgical incision and drainage were performed in our department, and a percutaneous vacuum drain was placed. To provide a more definitive treatment, endoscopic sinus surgery (ESS) was subsequently performed by otorhinolaryngologists. The patient was discharged without any complications 5 days after ESS. At a 1-year follow-up, no recurrence or notable neurological symptoms were observed. In the case we observed, the patient presented with an upper eyelid abscess and cellulitis, indicating possible orbital involvement. For such patients, a CT scan is necessary. Given the possibility of PPT, it is critical to perform a comprehensive differential diagnosis rather than defaulting to a straightforward approach involving abscess treatment.

Modern View on the Problem of Treatment of Traumatic Soft Tissue Detachments

The treatment of traumatic soft tissue detachments is an urgent problem for a first-level trauma hospital. This paper provides an analysis of the literature sources of the PubMed database, which are devoted to the classification, diagnosis and treatment of traumatic skin detachments. It was revealed that most of the works are publications of 1–2 clinical cases, only a few works are retrospective studies of patient groups. Currently, there is no generally accepted classification of traumatic detachment of soft tissues, due to the complexity and mosaic nature of pathoanatomical signs. According to the tactics of treatment, there is a difference in approaches for low-energy trauma (sports injury) and high-energy impact (traffic accidents, falls from a height). In the first case, the treatment methods are compression therapy, physiotherapy, and in rare cases, puncture. In the second case, puncture and drainage are the main method of treatment, and in persistent recurrent cases, chemical ablation or open surgery to excise the capsule in combination with vacuum drainage are the methods of treatment. Methods of endoscopic treatment of the walls of the detachment, ligation of the lymphatic vessels around the detachment, and the use of blockable sutures for obliteration of the detachment cavity are currently new methods of treatment, which effectiveness requires further study.

Single-catheter minimally invasive method of interventional continuous vacuum drainage for the treatment of lactational purulent mastitis

Single-catheter minimally invasive method of interventional continuous vacuum drainage for the treatment of lactational purulent mastitis

(140) Penile Length and Girth Restoration in Mb Peyronie: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis

Abstract Introduction Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, narrowing and shortening, which eventually compromise sexual function. Objective The presented technique is a less invasive approach that gives few complications, has a natural cosmetic outcome with preserved preputium, and high patient satisfaction. Methods In the period between December 2017 and May 2022, 65pts aged 33y to 78y underwent complex corporoplasty with inflatable penile prosthesis implantation. Mean penile curvature was 70 o (60 o -95 o ). Average penile shortening was 3.2cm (1 - 5.5cm), and girth narrowing 2.5cm (0 - 4cm). The surgical approach was thru penos-crotal incision, followed by direct dissection of NVB from tunica albuginea, penile eversion, composite corporoplasty (for transversal grafting 0.5mm thick porcine dermal graft, and for longitudinal graft composite semi-resorbable soft mash), and 3-piece inflatable penile prosthesis implantation. Postoperative vacuum drainage and compressive dressing were left in place for one week. Results Follow-up was 2-58 months (mean 21). Penile shape (corrected curvature, length and girth) was restored in all patients. In the first 4 weeks postoperatively 12pts had mild scrotal oedema; 8pts developed mild scrotal haematoma; 7pts developed penile skin oedema; 5pts had a transitory loss of sensitivity. All patients 5 weeks postoperatively started with sexual intercourse. All patients 12 weeks after surgery reported satisfactory aesthetical and functional results with no visible scaring related to surgery. Five pts (12-23 months after surgery) had prosthesis malfunction that needed reimplantation of the prosthesis. Conclusions Penile eversion thru peno-scrotal incision with preserving the prepuce for complex reconstructive surgery of PD is safe and gives the natural aesthetic appearance and good functional result with low complication rate. The high satisfaction rate for the patients is the most important aspect of this surgical method. Disclosure No

Vacuum therapy for the prevention of suppurations in sutured soft tissue wounds. First experience

Infectious and inflammatory processes in sutured soft tissue wounds are met in 3–22% of cases despite the strict following of aseptic and antiseptic rules, application of new antiseptic agents with high bactericidal effect as well as improved techniques for prevention and management of wound infection.Objective. To perform a comparative analysis on healing processes in sutured soft tissue wounds after surgical interventions in which purulent-necrotic processes have developed.Materials and methods. All patients were divided into two groups – main and control. Patients from the main group (n = 58) had vacuum drainage of subcutaneous tissues in sutured wounds after surgery from June 2019 till November 2021. Case-histories of 80 patients from the control group were analyzed retrospectively; the researchers assessed outcomes after surgical management. In these patients, drainage of subcutaneous tissues in sutured wounds after surgery for purulent-necrotic processes in soft tissues was done using the traditional flow-washing technique. Both studied groups were comparable in sex, age and co-morbidity.Results. In the control group, complications in the form of suppurated lesions were noted in 17 (17.5 %) patients. In 10 (12.5 %) patients with marginal skin necrosis, there was suture dehiscence. None of 58 patients from the main group in whom surgical wounds were treated with the technique of vacuum drainage developed by us had any purulent-septic complications. In all cases, wounds healed with the primary intention.Conclusion. The technique of vacuum drainage developed by us allowed to achieve better outcomes at the early postoperative period.

Research on the Bearing Capacity and Sustainable Construction of a Vacuum Drainage Pipe Pile

The vacuum drainage pipe (VDP) pile is a new type of pipe pile on which the current research is mainly focused on laboratory tests. There is little research on bearing characteristics and carbon emissions in practical engineering. To further explore the bearing capacity and sustainable construction of vacuum drainage pipe piles, static load tests were conducted to investigate the single-pile bearing capacity of ordinary pipe piles and vacuum drainage pipe piles, as well as soil settlement monitoring around the piles. Then, the Q-S curves of the two piles, the pile-side friction resistance under different pile top loads, and the development law of pile end resistance were compared and analyzed. Finally, based on the guidelines of the IPCC, the energy-saving and emission-reduction effects of VDP piles in practical engineering were estimated. The results indicate that, after vacuum consolidation, the VDP pile basically eliminates the phenomenon of soil compaction and does not cause excessive relative displacement of the pile and soil. VDP piles have increased lateral friction resistance, and compared to traditional piles, their ultimate bearing capacity is increased by 17.6%. Compared with traditional methods, the VDP pile method can reduce carbon emissions by 31.4%. This study provides guidance for the production and design of future VDP piles and demonstrates the potential of VDP piles for energy conservation and emission reduction in comparison to traditional methods.

Vacuum Therapy in Complex Treatment of Purulent-Necrotic Diseases of Soft Tissues: Clinical Cases

Background. Radical surgeries for phlegmons, abscesses, necrotizing infection are often followed by extensive wounds which require an individual approach to their rapid closure by means of plastic surgery methods. In such a case, the optimal wound therapy is primary healing with the use of vacuum therapy.Cases description. The study involved three clinical trials of patients with acute purulent-necrotic diseases of soft tissues of various localizations, volumes and grades, for which vacuum therapy was used as a part of complex therapy. Surgical interventions are proved to be urgently performed in acute purulent-necrotic diseases. Early reconstructive skin and bone plastic surgery aimed at closing post-operative wound defects is also very important.Conclusion. In the demonstrated clinical cases, the purulent process was stopped and wound therapy was performed by means of primary healing, which undoubtedly ensures medical and social rehabilitation of such patients. Notably, vacuum drainage is not an independent method, but an important component in the complex active surgical treatment of purulent wounds.

ROLE OF TRANEXAMIC ACID IN PREVENTING SEROMA FORMATION AFTER VENTRAL HERNIA REPAIR

The current analysis aimed to evaluate the role of tranexamic acid in preventing seroma formation after ventral hernia repair. This cross-sectional study was conducted at Bakhtawar Amin Trust Hospital Multan from 20th Jan 2020 to 20th Jan 2021. The study included patients diagnosed with ventral hernia repair. Those with cirrhosis, strangled hernias, uncontrolled diabetes mellitus, and bleeding disorders were excluded. The volume of seroma was measured using a vacuum drain. On the fifth post-operative day, 500 mg of oral tranexamic acid was given for 12 hours, and 1gm of IV tranexamic acid was given after skin closure. Statistical significance was calculated using the Chi-square test. P-value < .05 was considered statistically significant. A total of 110 patients were included in the study. 82 (74.5%) were females, while 28 (25.5%) were male. The patients were aged 45 years. Postoperatively, in 89 patients (81%), the seroma resolved in 5 days; in 21 patients (19%), it took more than 5 days to subside. Tranexamic acid significantly reduces post-operative seroma formation in ventral hernia repair.

Challenges of Epidural Hematoma Treatment after Cranioplasty: Case Report and Review of the Literature

Cranioplasty has its risks and complications as all surgical procedures. Treatment of complications are poorly known and could raise significant challenges. One of these complications is epidural fluid collection (EFC). We presented a case of recurrence EFC with deterioration of consciousness. A decompressive craniectomy was performed after rotten subdural hematoma and craniectomy so a cranioplasty was done after more than a half year of cured infection. An EFC occurred next day and one month after the cranioplasty. Due to many repetitive surgeries and head computed tomography scans a vacuum drainage system was formed. After twelve days of treatment the patient improved and the EDC disappeared with this system. We tried to search possible causes and treatment methods for EFC in literature. However, the pathogenesis is still unknown and treatment is only symptomatic.

EGS P04 Transgastric drainage of oesophageal perforations: The largest case series

Abstract Background Oesophageal perforation is associated with a high morbidity and mortality. Multiple operative and non-operative management strategies have been described. We first described the novel technique of transgastric drainage of oesophageal injuries in 2008. This has since been adopted across other units in the UK and Ireland. The technique exteriorises the site of the perforation by establishing vacuum drainage of the lumen of the oesophagus, whilst maintaining luminal patency and thereby encouraging healing by secondary intention. We present our 10 year experience with the largest case series in the literature. Methods A retrospective analysis was undertaken of all patients with oesophageal perforation treated with transgastric drainage, over the last 10 years, in our specialist unit. Transgastric drainage was performed using a 36 Fr Chest drain inserted through the stomach, into the oesophageal lumen above the proximal extent of the perforation. This was endoscopically performed with either laparoscopic or open guidance. Gastropexy was performed. Continuous suction of -10cm water was applied to the drain until no leak was noted. Mediastinal decontamination and drainage was performed as needed. Nutrition was provided by total parenteral nutrition or feeding jejunostomy. Results 35 patients were treated with transgastric drain. 68% (n=24) were male. Median age was 67 (26–84). 60% (n=21) being spontaneous perforations and 31% (n=11) were iatrogenic. Inpatient and 30-day mortality was 14% (n=5). Among patients who survived, the median length to resolution of leak on imaging was 34.5 days (6–80). Median length of stay was 39.5 (16–84) days. Conclusions Transgastric drainage can be successfully used to treat oesophageal perforations of varied lengths. The mortality rate of 14% compares favourably with other methods of management for oesophageal perforation.

Changes in the Properties of Hot Pressing Pulp Molded Products Depending on the Pulp Types and Manufacturing Conditions

Pulp molded product has become an important product that can be a promising substitute for plastic products, such as packaging material. In this study, the properties of hot pressing pulp molded product were evaluated based on the types of applied pulp and the conditions of pulp molded products manufacturing in order to provide basic concepts for optimizing and upgrading the quality of the hot pressing pulp molded products.BRThe experimental results obtained using a pilot pulp molded product simulator showed that the pulp molded product samples made with softwood CTMP showed higher bulk and higher tensile strength than the samples made with hardwood BKP and ONP. The vacuum drainage efficiency of the CTMP pulp molded product samples was lower than that of ONP pulp molded product samples. The higher drying temperature and higher drying time of the hot pressing process resulted in the lower bulk and higher tensile strength. However, the mechanical properties, such as tensile strength and stiffness, decreased for severe hot pressing conditions, e.g., 250 °C drying temperature or 3 min drying time.

Comparative Study of Multifunctional Irrigation-assisted Vacuum Drainage, Vacuum Sealing Drainage and the Penrose Drain in Treating Severe Multi-space Deep Fascial Infection in the Head and Neck.

We aimed to compare multifunctional irrigation-assisted vacuum drainage (MIVD), vacuum sealing drainage (VSD) and the Penrose drain in treating severe multi-space deep fascial infection (DFI) in head and neck. A retrospective study was conducted on 113 patients who had suffered from severe multi-space DFI in head and neck and underwent surgical treatment. Patients were divided into the MIVD group, the VSD group, and the Penrose group according to their treatment. Baseline characteristics and clinical outcome data regarding infection control, clinicians' workload, surgical procedure required, and cost were analyzed. Duration of antibiotic administration was significantly shorter using MIVD and VSD than Penrose drains (p = 0.002 with MIVD, p = 0.008 with VSD). Hospital stay in the MIVD group was shorter than the Penrose group (p = 0.034). Compared to the other two groups, more times of manual irrigation were needed in higher frequency in the Penrose group (p < 0.001). Longer Incision and more surgical operation were required in the VSD group than the other two groups (p < 0.001). The treatment cost in the VSD group was higher than the MIVD group (p = 0.045) and the Penrose group (p < 0.001). In the treatment of severe multi-space DFI in head and neck, MIVD and VSD are superior to the Penrose drain in infection control and reduction in clinicians' workload. Meanwhile, MIVD, with fewer surgical procedures required and less cost, seems to be a more promising method than VSD.

Effect of freezing temperature on dewatering, consolidation properties, and microstructure of landfill sludge

There is currently a considerable amount of landfill sludge (LS) accumulating worldwide, threatening the surrounding environment and land safety. It is urgent to dewater and reduce LS. Chemical conditioning is the most common treatment for LS, which can pollute the environment and limit resource exploitation. Therefore, a more environmentally friendly and efficient freeze-thaw combined vacuum preloading method is proposed. Experimental studies were conducted to investigate the influence of different freezing temperatures on the dewatering properties, compression and consolidation features, and the mechanism of microstructural change in LS. The results show that the freezing temperature has an important influence on the dewatering, compression, vacuum drainage, consolidation, and microstructure characteristics of LS. The compressibility of LS does not improve when the freezing rate is too high. Freeze-thaw cycles can improve sludge's permeability and consolidation properties by one to two orders of magnitude, and a suitable freezing temperature can significantly improve sludge's permeability and consolidation properties. After vacuum drainage and consolidation, the maximum volume reduction ratio of sludge can reach 55.3%, and the water content of LS can be reduced from 86% to 66%. The distribution of large pores and mesopores in LS increases as the freezing temperature decreases, reaching a maximum of −15 °C, which can substantially improve permeability, drainage, and consolidation efficiency.

The Efficacy of Posterior Fasciotomy Versus Inserted Vacuum Drainage in Reducing Postoperative Surgical Site Infection in Open Achilles Tendon Repair: A Prospective Cohort Study With Inverse Probability Treatment Weight Propensity Score Analysis

Posterior crural fasciotomy (PF) may reduce postoperative surgical site infection (SSI) rate compared to inserted vacuum suction drainage (VD) in open Achilles tendon repair surgery. Thus, we aimed to compare the postoperative SSI rate between PF and VD in open Achilles's tendon repair surgery. A prospective, single-centered, nonrandomized controlled study of consecutive adult patients undergoing primary open Achilles tendon repair was performed at tertiary referral hospital between January 2017 and January 2020. Patients received either PF or VD from 2 experienced surgeons. Data were collected on demographic, clinical, and intraoperative characteristics along with postoperative SSI and other outcomes. The primary outcome was SSI rate. Secondary outcomes were Achilles tendon total rupture score, functional foot index, and visual analogue scale. A total of 60 patients were eligible and included in the final analysis (PF group n = 30 and VD group n = 30). Two (6.7%) patients in the PF group and 5 (16.7%) patients in the VD group experience postoperative SSI (crude risk ratio 0.40; 95% confidence interval 0.08, 1.90; p = .228). In inverse-probability-treatment-weighted propensity score analysis, the PF group had a significantly lower SSI rate than the VD group (adjusted risk ratio 0.30; 95% confidence interval 0.01, 0.91; p = .033). Inverse-probability-treatment-weighted propensity score analysis of Achilles tendon total rupture score along with crude analysis of total functional foot index and visual analogue scale were also significantly better in the PF group than the VD group (all p < .05). PF during open Achilles repair was associated with a significant reduction in postoperative SSI infection rate compared to VD.

Laboratory test of waste mud treated by the flocculation-vacuum-curing integrated method

An integrated method of flocculation, vacuum preloading and solidification using curing agents was proposed to treat waste engineering mud. Flocculation, vacuum preloading and solidification work together to turn waste mud into cured soil that can be used as filling material for embankments or foundation pit filling. Model tests were carried out to verify the effectiveness of the method. A series of vane shear tests, unconfined compression tests, nuclear magnetic resonance tests and scanning electron microscopy tests were conducted to compare the strength of cured soil after treatment with different methods and investigate the solidification mechanism. The results showed that the flocculant accelerates the drainage speed in the early stage of vacuum drainage, and the curing agent consumes water and generates hydrates to fill the soil pores in the later stage of vacuum preloading to achieve rapid solidification of soil. Compared with vacuum preloading + flocculation method, the proposed method can achieve a significantly higher strength of solidified soil. The experimental results indicate the effectiveness of the proposed integrated treatment method. Cement + retarder + quicklime is an ideal combination of curing agents for the proposed method to treat waste mud from bored pile construction.

A Prospective, Randomized, Double-blind Trial of the Use of Fibrin Sealant for the Bilateral Sagittal Split Ramus Osteotomy (BSSRO)

Background: Bilateral sagittal split ramus osteotomy surgery (BSSRO) was done by splitting the mandibular ramus and re-positioning the Mandibular arch to achieve the proper dental occlusion. The common postoperative complication is bleeding and hematoma. The suction drains were used to prevent such problems. Fibrin sealant has been used in several surgical procedures to aid in hemostasis. Objective: The present study aims to study whether the intraoperative application of Fibrin sealant can reduce the amount of postoperative drainage in BSSRO operation. Materials and Methods: We performed a prospective, randomized, double-blind study of 20 patients who underwent BSSRO surgery or BSSRO with combined Le fort I and Genioplasty surgery between September 2018 and October 2019, so the total samples were 40 operative sides. Patients were randomly divided into one of two groups based on whether they received intraoperative Fibrin sealant. The volume of the wound drainage was recorded every 24 hours for 72 hours. Results: The amount of postoperative drainage of the first and second 24 hours was not significantly different. The difference in the pain score and satisfaction score between the two groups were also the same. Conclusion: The intraoperative fibrin sealant did not have a significant benefit in BSSRO to reduce bleeding. Retaining the vacuum drainage only is sufficient and cost-effective to prevent hematoma in BSSRO. Keywords: Fibrin glue; Fibrin sealant; BSSRO; Hunsuck; Hematoma

Management of post-operative pancreatic fistulas following Longmire\u2013Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

BackgroundPylorus-preserving pancreatoduodenectomy (PPPD) with pancreatogastrostomy is a standard surgical procedure for pancreatic head tumors, duodenal tumors and distal cholangiocarcinomas. Post-operative pancreatic fistulas (POPF) are a major complication causing relevant morbidity and mortality. Endoscopic vacuum therapy (EVT) has become a widely used method for the treatment of intestinal perforations and leakages. Here we report on a pilot single center series of 8 POPF cases specifically caused by dehiscences of the pancreatogastric anastomosis (PGD), successfully managed by EVT.MethodsWe included all patients with PGD after PPPD, who were treated with EVT between 07/2017 and 08/2020. For EVT a vacuum drainage film (EVT film) or open-pore polyurethane foam sponge (EVT sponge) was fixed to a 14Fr or 16Fr suction catheter and placed endoscopically within the PGD for intracavitary EVT with continuous suction between − 100 and − 150 mmHg. The EVT film/sponge was exchanged twice per week. EVT was discontinued when the PGD was sufficiently healed.ResultsPGD closure was achieved in 7 of 8 patients after a mean EVT time of 16 days (range 8–38) and 3 EVT film/sponge exchanges (range 1–9). One patient died on day 18 after PPPD from acute hemorrhagic shock, unlikely related to EVT, before effectiveness of EVT could be fully achieved. There were no adverse events directly attributable to EVT.ConclusionsEVT could be an effective and safe addition to our therapeutic armamentarium in the management of POPF with PGD. Unless prospective comparative studies are available, EVT as minimally invasive therapeutic alternative should be considered individually by an interdisciplinary team involving endoscopists, surgeons and radiologists.

Indwelling Pleural Catheters for Malignant Pleural Effusion: A Time for Action.

Malignant pleural effusion (MPE) resulting from metastatic spread to the pleura frequently occurs in patients with primary lung, breast, hematological, gastrointestinal, and gynecological cancers. These effusions tend to reaccumulate quickly, and the patient requires increasingly frequent thoracentesis. An indwelling pleural catheter allows for dramatic improvement in quality of life as the patient has the power to ease her/his own suffering by draining the effusion at home when shortness of breath and/or chest pain intensifies. Patients with MPE need home healthcare support to address symptom management related to complications of advanced metastatic cancer and antineoplasm treatment regimens. The financial obstacles for the home healthcare agency are explored by using agency supply costs, per visit costs, and the patient-driven groupings reimbursement mode grouper to estimate reimbursement. Care for a home healthcare patient with MPE costs Medicare approximately $64.50 per day, markedly less than costs for hospitalization and outpatient thoracentesis. Unfortunately, agencies must absorb the cost of vacuum drainage bottles. Whereas a small positive balance of $291 was estimated for the first 30-day posthospital episode, losses were estimated at $1,185 to $1,633 for subsequent 30-day episodes. Absorbing these costs has become extremely difficult as home healthcare agencies are experiencing unprecedented COVID-19 infection control and staffing-related costs.