Use of Indwelling Pleural Catheter in the Management of patients with Malignant Pleural Effusion

Abstract

The utilization of small-bore catheters for outpatient drainage of MPEs has been advocated in a number of case reports, in which indwelling pleural catheter allows periodic home drainage of MPEs and it is as effective as chest tubes when used for chemical pleurodesis, with significantly less pain, cost and hospitalization (Musani et al., 2004). In addition, indwelling pleural catheter has proven efficacy in the management of refractory MPE in patients who cannot achieve pleurodesis because of ‘trapped lung’ syndrome (Pien et al., 2001). This study was performed to compare clinical outcomes in patients who were treated with pleural catheter insertion to those with tube thoracostomy as regarding complications, duration of hospital stay. quality of life and monitoring the use of indwelling pleural catheter in patients with previous failed pleurodesis or trapped lung regarding the rate of spontaneous pleurodesis. The present study was prospective comparative study which was conducted upon sixty five patients with malignant pleural effusion with biopsy proven diagnosis of malignancy (either primary or secondary) and they divided into 25 inpatient with tube thoracostomy (group A) and 25 outpatient with pleural catheter (group B), the patients and their families were instructed on the use and maintenance of the catheter after its insertion. both followed up after 4 weeks of pleurodesis and 15 outpatient with indwelling pleural catheter (group C) followed up for 6 months from insertion of the catheter and the patients and their families were also instructed on the use and maintenance of the catheter after its insertion Results: • In comparison between chest tube group and pleural catheter group, there was significant statistical difference between both groups in modified Borg scale for dyspnea after insertion with 43 % improvement in dyspnea in pleural catheter group to 41% in chest tube group. • In comparison between chest tube group and pleural catheter group, there was significant statistical difference between both groups in the duration of catheter which was 4 (3 – 5) days to 11 (10 –10.25) days in chest tube group. • In comparison between chest tube group and pleural catheter group, there was significant statistical difference between both groups in the cost of hospital and medication and total cost as the cost of hospital and medication was 1400±780 L.E in the pleural catheter group while in chest tube group was 11520 ± 1895.61L.E and the total cost was 5520 ± 1760 in pleural catheter group and 14020.00 ± 1895.61 L.E in chest tube group. • In comparison between chest tube group and pleural catheter group, there was significant statistical difference between both groups in complication regarding pain at the site of insertion which 100% in chest tube group to zero % in pleural catheter group. • In group (C) spontaneous pleurodesis occurred 46.7% and the predictors for spontaneous pleurodesis were the shorter duration of catheter and low modified Borg scale for dyspnea before insertion and complications were26.7% blocked catheter, 13.3% pain, 6.7% for each of cellutis an empyma and dislodged catheter.