Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter

Study objective: Patients with symptomatic malignant pleural effusion are u sually treated with large-bore chest tube placement and pleurodesis requiri ng greater than or equal to 3 days of hospitalization. We sought to demonst rate the feasibility of ambulatory drainage and sclerosis using a small-bor e pigtail catheter in patients with malignant pleural effusions, We reasone d that this approach would improve symptoms and quality of life at a reduce d cost, Methods: A 14F pigtail catheter was percutaneously inserted into the pleura l space and connected to a closed gravity-drainage bag system. The patients were instructed in the use of the drainage system and discharged to return for sclerosis with 4 g of talc after the drainage was < 100 mL/24 h, Patie nts were graded for dyspnea and performances status using the Eastern Coope rative Oncology Group score (ECOG) and baseline and transitional dyspnea in dex score (BDI-TDI) before tube placement and again at 30 days. Radiographi c response was graded as total response, partial response, or failure. Tele phone follow-up was initiated when the patient could not return for evaluat ion. Results: Ten ambulatory women, ages 41 to 79 years, were enrolled. The ches t tube was left in place from 1 to 10 days, draining a mean of 2,956 mL (1, 685 to 6,050 mL). Only two patients were unable to undergo sclerosis owing to catheter dislodgment and minimal drainage, Six reported symptomatic impr ovement at 30 days confirmed by TDI and ECOG scores in four of six. One wit h a prior history of a lobectomy was found to have a chylous pleural effusi on and experienced a hydropneumothorax, for which sclerosis was unsuccessfu l, One died in hospital on day 26 after sclerosis despite radiographic reso lution, Of the four patients who had improved dyspnea and functional status by TDI and EGOG scores, radiographic response was complete in three and pa rtial in one, Two of the six were not able to return for follow-up because of weakness but reported improvement by telephone inquiry. Conclusion: Ambulatory sclerosis of malignant effusion using a small-bore c atheter is a feasible alternative to inpatient sclerosis with a large-bore chest tube, especially in patients with strong preferences for outpatient c are.