Recurrent pleural effusion is a therapeutic challenge for the physician and can be a source of continued morbidity for the patient. The use of intermittent pleural space drainage via an indwelling pleural catheter (Pleurx, Denver Biomedical) is one solution. Not only does the catheter allow for outpatient drainage, it can effect mechanical, or “auto” pleurodesis; its eventual removal results in no effusion recurrence. This study examines a case series of patients receiving a Pleurx catheter, the correlation of volume and frequency of drainages, and the concept of auto-pleurodesis.
We retrospectively analyzed the placement of 92 Pleurx catheters. The catheters were placed for both malignant and non-malignant recurrent pleural effusions. The volume of fluid was recorded at the time of catheter placement. Patients were then either admitted to hospice for palliation by drainage, or returned to the clinic for drainage. For this latter group, the catheters were removed when the patients clinically achieved pleurodesis as evidenced by resolution of drainage volumes or symptoms and radiographic stability.
A total of 92 catheters were placed. 46 achieved pleurodesis (32 malignant, 14 non-malignant), 27 continued palliative drainage, and 19 were failures. Thus there was a success rate of 71% (46/65) in the catheters which were placed with the intent of pleurodesis. Of these 46, the median initial thoracentesis volume was 1000 cc (range 175-3300 cc). The median number of drains performed for each patient was 8 (range 1 to 69). After log transformation of both sets of values, no correlation between the initial volume and number of drains was found (Pearson correlation = -.003 [p=.985]).
The Pleurx catheter is an effective outpatient method to manage recurrent pleural effusions through palliative drainage or pleurodesis. The size of the initial effusion does not predict the number of drainages.
The Pleurx catheter is a safe, relatively inexpensive method which should be considered first-line therapy for recurrent malignant and non-malignant pleural effusions.
J.A. O’Hea, None.