Treatment of malignant pleural effusions with tunneled long-term drainage catheters

PURPOSE: To assess the effectiveness of tunneled pleural catheters (TPCs) i n the treatment of malignant pleural effusions (MPEs). MATERIALS AND METHODS: Twenty-eight patients with symptomatic MPEs had 31 h emithoraces treated with TPCs placed under image guidance. Chemical sclerot herapy had failed in two patients and two had symptomatic locules. Drainage was accomplished by intermittent connection to vacuum bottles. Pleurodesis was considered achieved when three consecutive outputs were scant and imag ing showed no residual fluid. RESULTS: All catheters were successfully placed. Dyspnea improved in 94% (2 9 of 31 hemithoraces) at 48 hours and 91% (20 of 22 patients) at 30 days. C ontrol of the MPE was achieved in 90% of hemithoraces (28/31), although fiv e required ancillary procedures. Pleurodesis occurred in 42% (13 of 31) of hemithoraces, including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule. Continued drainage without pleurodesi s controlled the effusion in 48% (15 of 31). In only 7% was hospital time n ecessary for care related to the TPC. Early, transient catheter-related pai n was common, but only three complications (in two patients) occurred. Neit her of these altered patient care. CONCLUSIONS: Regardless of whether pleurodesis is achieved, TPCs provide ef fective long-term outpatient palliation of MPEs.