Peritoneal and pleural ports for management of refractory ascites and pleural effusions: assessment of impact on patient quality of life and hospice/home nursing care.
OBJECTIVE
Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care.


METHODS
Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart review and interviews were held with patients and nursing care providers. Mean follow-up was 59 days.


RESULTS
On a 10-point scale, QOL improvement, compared to that prior to port placement, was rated a mean of 9.5 by patients and 9.0 by the nursing staff. Both patients and nurses reported a high degree of convenience (rated at 9.7 and 9.6, respectively) and improvement of symptoms and comfort (9.6 and 9.3, respectively). Nursing staff reported a high degree of comfort (9.9) using the aspiration ports. Six of 14 pleural ports were removed following pleurodesis. One pleural port was removed due to patient discomfort and another due to pneumothorax. Two patients with pleural ports developed tumor seeding in the subcutaneous tissues. Of 14 peritoneal ports, 3 required removal for leaking and probable chemical cellulitis. Four became temporarily occluded with patency restored using tissue plasminogen activator (TPA) infusion.


CONCLUSIONS
Peritoneal and pleural ports offer a convenient and relatively safe alternative to frequent paracenteses/thoracenteses in the management of refractory ascites and pleural effusions. This approach can improve the QOL for patients with end-stage disease.
Monsky
Wayne L
WL
University of California, Davis Medical Center, Sacramento, California 95817, USA. wemonsky@msn.com
Yoneda
Ken Y
KY
MacMillan
John
J
Deutsch
Larry-Stuart
LS
Dong
Paul
P
Hourigan
Helen
H
Schwartz
Yvonne
Y
Magee
Stacey
S
Duffield
Curtis
C
Boak
Tammy
T
Cernilia
James
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000451:nursing / Q000628:therapy*; D002408:Catheters, Indwelling; D005260:Female; D006305:Health Status Indicators; D006701:Home Nursing; D017051:Hospice Care; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000451:nursing / Q000628:therapy*; D018700:Pleurodesis; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017211:Treatment Failure