title: Use of a pleural implantable access system for the management of malignant pleural effusion: the Institut Curie experience.
abstract: OBJECTIVE
  Malignant pleural effusion has a very poor prognosis, raises problems of medical management, and impairs quality of life. The authors report the first experience of a pleural implantable access system for the treatment of recurrent symptomatic malignant pleural effusion.
  
  
  METHODS
  Prospective follow-up of 29 patients between August 20, 2005 and August 1, 2007 in a single center. Thirty-four pleural implantable access systems were placed in 29 patients (23 patients with breast cancers, 4 patients with bilateral placements, and 1 patient with a replacement) under sedation after the decision of a multidisciplinary meeting.
  
  
  RESULTS
  Twenty-eight patients obtained partial or complete relief of their dyspnea. Six patients underwent pleurodesis after a maximum of 2 months. Fifteen patients were receiving chemotherapy at the time of placement. Seven patients died at the Institut Curie or in a palliative care unit without returning home. The other 22 patients presented a total of 280 days of hospitalization for 2,717 days of catheter implantation. No placement failures were observed in this series. Two infectious complications (infectious pneumonia and skin infection over the puncture site) and two mechanical complications (expulsion of the port and disconnection between the port and the catheter) were observed and easily treated. One patient had loculation of the pleural cavity develop after 16 thoracenteses making further thoracentesis ineffective.
  
  
  CONCLUSIONS
  The pleural implantable access system is an interesting alternative in terms of efficacy and safety for the outpatient management of malignant pleural effusion. It presents a number of advantages in terms of comfort and infectious risk compared with tunnelled pleural catheters.
authors: Institut Curie, Paris, France.
authors: Catherine
authors: C
authors: Daniel
authors: Irène
authors: I
authors: Kriegel
authors: Sophie
authors: S
authors: Di Maria
authors: Gabriela
authors: G
authors: Patrubani
authors: Regine
authors: R
authors: Levesque
authors: Alain
authors: A
authors: Livartowski
authors: Marc
authors: M
authors: Esteve
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004864:Equipment and Supplies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012449:Safety; D012720:Severity of Illness Index; D016896:Treatment Outcome