Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter

Putnam, Joe B.; Walsh, Garrett L.; Swisher, Stephen G.; Roth, Jack A.; Suell, Douglas M.; Vaporciyan, Ara A.; Smythe, W. Roy; Merriman, Kelly W.; DeFord, Linda L.

doi:10.1016/s0003-4975(99)01482-4

Cited by 233 publications

(135 citation statements)

References 20 publications

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“…One of the major drawbacks of pleurodesis is that it often necessitates a 5-to 7-day hospitalization (70,84). TPCs alone have been found to cause spontaneous pleurodesis and in a randomized multicenter study with aggressive daily drainage, it was 54 days compared to a less aggressive interval draining (90 days) (55,72).…”

Section: Rapid Pleurodesismentioning

confidence: 99%

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Desai

Lee

2017

J. Thorac. Dis.

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Malignant pleural effusion (MPE) is a known complication of both thoracic and extra thoracic malignancies. The presence of MPE regardless of the primary site translates into advanced stage disease.Diagnosis and management of MPE with the goals of palliation and improving quality of life poses a challenge for chest physicians. Recently, multiple studies have made attempts to answer questions regarding optimal management in various clinical scenarios. We will review the current evidence and available options for the management of MPE.

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Section: Rapid Pleurodesismentioning

confidence: 99%

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Desai

Lee

2017

J. Thorac. Dis.

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“…The mere presence of a TC increases the risk of infection. (3,10) Cases of empyema due to methicillin-resistant S. aureus have been reported as a complication of the use of TCs. (18) In vascular catheter-related infection, antibiotic resistance is considered a significant problem.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, there is a high risk of empyema in such cases. (3,10) In summary, TCs are a gateway into the thorax and provide a suitable environment for the proliferation of microorganisms. Risk factors, such as advanced age, having been submitted to prolonged catheterization, comorbidities, and having an inoperable malignancy, increase the risk of catheter-related infection.…”

Section: Resultsmentioning

confidence: 99%

Infecções relacionadas a cateteres torácicos

et al. 2010

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Objective: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. Methods: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheterrelated infection. Results: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). Conclusions: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.Keywords: Catheter-related infections; Thoracic surgery; Bacterial infections. ResumoObjetivo: Determinar o status de colonização de uma amostra de pacientes que recebeu cateteres torácicos (CTs) e correlacionar esse status a possíveis fatores prognósticos. Métodos: Estudo retrospectivo com 48 pacientes (17 mulheres e 31 homens) que receberam CTs no Departamento de Cirurgia Torácica do Hospital Universitário Adnan Menderes, localizado na cidade de Aydin, Turquia, entre dezembro de 2008 e março de 2009. Amostras de sangue para cultura foram coletadas da porção distal dos CTs e de cada um dos 48 pacientes. Procuramos por correlações entre culturas positivas e possíveis fatores prognósticos de infecção. Resultados: Resultados positivos de cultura em amostras de CT ocorreram somente 3 pacientes, em sangue em 2, e nas duas amostras em outros 2. A idade avançada correlacionou-se com culturas positivas das amostras de CT e sangue (r = 0,512 e r = 0,312, respectivamente; p < 0,05), assim como o uso prolongado do CT e com culturas positivas das mesmas amostras (r = 0,347 e r = 0,372, respectivamente; p < 0,05). Houve uma correlação significativa entre o status cirúrgico dos pacientes (aqueles submetidos a cirurgias) e culturas positivas somente das amostras de CT (p < 0,05), mas a presença de malignidade inoperável correlacionou-se com o crescimento bacteriano em ambos os tipos de amostras (p < 0,05 ...

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“…In a previous paper, we also observed a pleurodesis rate in line with data reported in literature (3). The variable success rate of pleurodesis relates to different types of malignancy, which have different pathogenesis leading to the effusion, such as a pleural spreading for mesothelioma or mediastinal node metastases and occlusion of the lymphatic for breast cancer, or other factors such as the degree of lung entrapment by tumour growth (7,(12)(13)(14)(15)(16). The cost of an IPC may appear as an issue, mainly due to the cost of the device and the single-use vacuum bottles.…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

Management of malignant pleural effusions in patients with trapped lung with indwelling pleural catheter: how to do it

2016

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Malignant pleural effusion (MPE) is a well-known sign of an end-stage cancer and affects the quality of life of these patients. The primary goal in the management of MPE should be a soothing treatment with the palliation of symptoms. Pleurodesis may be accomplished with chemical irritation of the pleura and represents the commonest treatment of MPE with palliative intent. Pleurodesis may be achieved through a chest drainage placement or a video-assisted thoracic surgery (VATS) procedure. The uniportal VATS talc poudrage is considered the gold standard of care for fit patients, while talc slurry (through the chest drainage)is reserved to those patients with important comorbidities not tolerating a surgical procedure. However, if the lung remains trapped after fluid evacuation or if the daily fluid output after chest tube insertion is major than 300 mL/day, the talc pleurodesis is likely to fail. Therefore, in those patients who are unfit for pleurodesis (low performance status or comorbidity), or with a recurrent MPE after chemical pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunnelled indwelling pleural catheter (IPC) effectively relieved dyspnoea without complications. The treatment of recurrent MPE with an IPC reduces symptoms and improves quality of life in patients with end-stage cancers. The complication rate is low; therefore, the IPC can be easily managed at home. The IPC is safe, easy to place and effective for the palliation of MPE. It could help the clinical need of the thoracic surgeons and the other members of a multidisciplinary cancer team.

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Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter

Cited by 233 publications

References 20 publications

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Infecções relacionadas a cateteres torácicos

Management of malignant pleural effusions in patients with trapped lung with indwelling pleural catheter: how to do it

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