Management of Indwelling Tunneled Pleural Catheters

Re‐establishing indwelling pleural catheter patency with alteplase after failure of streptokinase

“…The decision for alteplase was in line with a recent modified Delphi consensus which recommended the use of alteplase in such situations [2]. The recommended dosage of alteplase is still not well established.…”

“…Following IPC insertion, symptomatic loculations may be present in up to 14% and as early as two months [1]. Management of these loculations include intrapleural (IP) fibrinolytics (with/ without dornase alfa) or placement of IPC in a different locule [2]. We describe the successful use of a single lowdose IP alteplase in both IPC blockage and symptomatic loculation drainage, following failed therapy with six doses of IP streptokinase.…”

Key Highlights From the American Association for Bronchology and Interventional Pulmonology Evidence-Informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters

“…Both articles address the diagnosis and management of IPC-related infections and general IPC management issues such as drainage schedules and evaluation of nondraining catheters. However, although the article by Gilbert et al5 includes infection control measures at the time of insertion, the AABIP guidelines focus exclusively on postinsertion IPC management. Where topics overlap, the majority of suggestions are harmonious, but there are also important areas of discordance.…”

“…Gilbert et al do not suggest any particular drainage regimen beyond stating that drainage should occur at least weekly; the AABIP guidelines provide more detailed suggestions for drainage schedule, based on patient preferences, lung reexpandability, and expected survival. Additionally, although the AABIP guidelines specifically address tunnel-tract infections, favoring catheter removal when coexistent with pleural space infection, the article by Gilbert et al5 does not differentiate between tunnel-tract and superficial IPCrelated infections, from either a definitional or management perspective. Methodologically, both panels used the Delphi processes to develop consensus statements.…”

“…Methodologically, both panels used the Delphi processes to develop consensus statements. However, the consensus process of Gilbert et al5 relied only on a nonsystematic literature review; the AABIP effort included a formal literature search and quality assessment, with the preplanned objective of making evidence-based recommendations when the volume and quality of literature allowed.…”