title: Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters.
abstract: 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.
authors.affiliation: Interventional Pulmonology Program, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104-4283, USA. amusani@mail.med.upenn.edu
authors.forename: Ali I
authors.initials: AI
authors.lastname: Musani
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Haas
authors.forename: Luis
authors.initials: L
authors.lastname: Seijo
authors.forename: Mary
authors.initials: M
authors.lastname: Wilby
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Sterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001943:Breast Neoplasms / Q000150:complications; D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies