Treatment of malignant pleural effusions with tunneled long-term drainage catheters.
OBJECTIVE
To assess the effectiveness of tunneled pleural catheters (TPCs) in the treatment of malignant pleural effusions (MPEs).


METHODS
Twenty-eight patients with symptomatic MPEs had 31 hemithoraces treated with TPCs placed under image guidance. Chemical sclerotherapy had failed in two patients and two had symptomatic locules. Drainage was accomplished by intermittent connection to vacuum bottles. Pleurodesis was considered achieved when three consecutive outputs were scant and imaging showed no residual fluid.


RESULTS
All catheters were successfully placed. Dyspnea improved in 94% (29 of 31 hemithoraces) at 48 hours and 91% (20 of 22 patients) at 30 days. Control of the MPE was achieved in 90% of hemithoraces (28/31), although five required ancillary procedures. Pleurodesis occurred in 42% (13 of 31) of hemithoraces, including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule. Continued drainage without pleurodesis controlled the effusion in 48% (15 of 31). In only 7% was hospital time necessary for care related to the TPC. Early, transient catheter-related pain was common, but only three complications (in two patients) occurred. Neither of these altered patient care.


CONCLUSIONS
Regardless of whether pleurodesis is achieved, TPCs provide effective long-term outpatient palliation of MPEs.
Department of Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA. pollak@biomed.med.yale.edu
J S
JS
Pollak
C M
CM
Burdge
M
M
Rosenblatt
J P
JP
Houston
W J
WJ
Hwu
J
J
Murren
D002408:Catheters, Indwelling; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis; D015911:Sclerotherapy; D013997:Time Factors