Indwelling Pleural Catheter: Management of Complications

Abstract

Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.

Malignant Pleural Effusion: A Multidisciplinary Approach

“… 103 Another complication is symptomatic loculation, which is treated with intrapleural enzyme therapy. 104 The recently published European and American guidelines state that both IPC and pleurodesis are definitive first-line interventions for symptomatic MPE with expandable lungs, and IPC is also recommended for patients with non-expandable lungs or those with failed pleurodesis 44 , 105 ( Fig. 6 ).…”

Malignant pleural disease

“…IPC complications include pain on insertion/drainage, symptomatic loculation (failure of fluid drainage due to formation of adhesions), infection (soft tissue, tract and pleural infection), catheter tract metastases and dislodgement [ 121 ]. Most complications can be managed conservatively and rarely require IPC removal [ 138 ]. Intrapleural fibrinolytic therapy can be administered for the symptomatic loculations that occur in up to 14% of IPC patients, the most commonly used agents being a single dose of alteplase (4–10 mg) or urokinase (100 000 IU) administered via the IPC [ 126 , 139 ].…”