P181 Indwelling pleural catheters for malignant pleural effusions – do septations change outcomes?

Abstract

IntroductionThe insertion of indwelling pleural catheters (IPCs) allows outpatient based management of pleural effusions and has been shown to be effective as a primary management strategy and following failed attempts at pleurodesis. The presence of septations may be associated with incomplete drainage and may make the procedure more complex. This study aimed to assess if the presence of septations on thoracic ultrasound changed the outcome of IPC insertion and to review complication rates.MethodProspective data is collected for patients undergoing insertion of IPCs at a tertiary pleural referral centre. Pre-procedure thoracic ultrasound is performed in all patients and a grading of septations made; no septations, mild (<4), moderate (4–9), severe septations (>9). Immediate, early (30 days) complications as well as six month follow-up data are recorded. This study is a retrospective analysis of this prospectively maintained database.ResultsA total of 47 patients with complete datasets were identified between 2013–2014; 34% (16/47) had mild/moderate/severe septations (n = 7, 5, 4 respectively) and 66% (31/47) had no septations. There was no significant difference in the number of patients achieving resolution of pleural effusion and pleurodesis whereby the IPC could be removed according to the presence of septations (pleurodesis in those with no septations 16%, 5/31 vs. 13%, 2/16 in those with septations, p = 1.0). There were no patients in either group in whom the drain was removed due lack of drainage in the context of a persistent pleural collection. There was no significant difference in overall complication rate according to the presence of septations (16%, 5/31, in the no septation group vs 13%, 2/16, in the septation group, p = 1.0).ConclusionThese results suggest that the presence of septations on the pre-insertion thoracic ultrasound do not affect the rate of pleurodesis or drain removal due to lack of drainage and persistent pleural effusion. The numbers in the study are small and a limitation is the lack of assessment of post-procedure breathlessness in our patients (e.g. with a visual analogue scale). The presence of septations should not deter consideration of IPC insertion in the management of malignant pleural effusions.

The role of interventional pulmonology in the diagnosis and management of undiagnosed pleural effusions

“…The choice for talc pleurodesis or IPC insertion should be a shared decision between physician and patient, with each offering unique advantages and disadvantages. While the IPC can be performed in an outpatient setting, it is associated with complications such as pleural infection or IPC blockages requiring further intervention and can result in discomfort or problems with sleep, and require regular aftercare 65 . Talc pleurodesis on the other hand, requires a hospital admission and will not be suitable for non-expansile lung, which often is difficult to predict without a prior large volume thoracentesis, but will not require repeated drainages (sometimes associated with discomfort) or specific aftercare required for IPCs.…”