Pleural Effusions: Outpatient Management with Pigtail Catheter Chest Tubes

Le, Linda Van; Parker, Leonard A.; DeMars, Leslie R.; MacKoul, Paul; Fowler, W. C.

doi:10.1006/gyno.1994.1196

Cited by 22 publications

(17 citation statements)

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“…Twenty-three patients (72%) had a CR, and 5 (16%) NR. Our results were similar to those reported by other workers [5, 8, 10, 15, 21, 22, 23, 24, 25]. …”

Section: Discussionsupporting

confidence: 82%

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The Value of Small-Bore Catheter Thoracostomy in the Treatment of Malignant Pleural Effusions

Şahin

Ünlü²,

Akkaya³

et al. 2001

Respiration

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Background: Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied. Objectives: To assess the efficacy and safety of small-bore catheter (Pleuracan^®) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions. Methods:Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates. Results: Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response rates of talc pleurodesis via small-bore catheter were found to be 84.2% [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (≤39.0°C) 6–24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days). Conclusion:Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a ‘standard’ 16- to 24-french chest drain, should be performed.

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“…Twenty-three patients (72%) had a CR, and 5 (16%) NR. Our results were similar to those reported by other workers [5, 8, 10, 15, 21, 22, 23, 24, 25]. …”

Section: Discussionsupporting

confidence: 82%

“…Inpatient drainage with large-bore chest tubes connected to wall suction followed by sclerosis is the most commonly used palliative intervention [17, 18, 19]. The success rate with small-bore chest tubes used on an inpatient basis ranges from 62 to 95% [5, 8, 15, 20, 21, 22, 23]. …”

Section: Discussionmentioning

confidence: 99%

The Value of Small-Bore Catheter Thoracostomy in the Treatment of Malignant Pleural Effusions

Şahin

Ünlü²,

Akkaya³

et al. 2001

Respiration

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“…[28][29][30][31][32] The use of small bore pigtail catheters has allowed outpatient treatment of malignant pleural effusions which have not responded to chemotherapy. 33 Empyemas are often successfully drained with ultrasonically placed small bore tubes with the aid of thrombolytic agents. 34 35 In the case of acute haemothorax, however, large bore tubes (28-30 F minimum) continue to be recommended for their dual role of drainage of the thoracic cavity and assessment of continuing blood loss.…”

Section: [C]mentioning

confidence: 99%

BTS guidelines for the insertion of a chest drain

Laws

Neville

Duffy

2003

Thorax

222

104

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“…For these reasons, the utilization of small-bore catheters for prolonged inpatient and/or outpatient drainage of MPEs has been advocated in a number of case reports [17, 18, 19, 20]. These early descriptions contributed to the development of a small-bore, flexible, tunneled pleural catheter (PC) that allows for periodic home drainage of MPEs.…”

Section: Introductionmentioning

confidence: 99%

Outpatient Management of Malignant Pleural Effusions with Small-Bore, Tunneled Pleural Catheters

et al. 2004

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Background: Malignant pleural effusions (MPEs) can produce significant respiratory symptoms and diminished quality of life in patients with terminal malignancies. Control of MPEs to palliate respiratory symptoms can be performed via several different approaches. Ideally, a minimally invasive procedure to control MPEs and to provide relief of respiratory symptoms would be optimal. Objective: To ascertain if control of MPEs can be achieved by outpatient management via a small-bore pleural catheter (PC) without the need for sclerosing agents. Methods: Retrospective chart analysis of 24 patients after outpatient insertion of PCs for recurrent, symptomatic MPEs followed by frequent home drainage of pleural fluid to relieve respiratory symptoms. Results: Symptomatic relief of respiratory symptoms was achieved in 100% of patients, while pleurodesis was achieved in 58% of patients in a mean of 39 days. Five patients (6 PCs) expired with the catheters in place. In these patients, all catheters remained in position and functional until the patients ultimately died from nonpleural disease progression. No major complications occurred during insertion of the catheter. Late complications included localized cellulitis and bacterial superinfection in three patients and tumor growth at the catheter site in one patient. Conclusions: The PCs used in the present study provided an effective modality not only to alleviate respiratory symptoms associated with MPE, but also to achieve pleurodesis in 58% of our patients. These catheters may provide a significantly less invasive outpatient approach to the palliative management of MPEs.

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Pleural Effusions: Outpatient Management with Pigtail Catheter Chest Tubes

Cited by 22 publications

References 0 publications

The Value of Small-Bore Catheter Thoracostomy in the Treatment of Malignant Pleural Effusions

The Value of Small-Bore Catheter Thoracostomy in the Treatment of Malignant Pleural Effusions

BTS guidelines for the insertion of a chest drain

Outpatient Management of Malignant Pleural Effusions with Small-Bore, Tunneled Pleural Catheters

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