PURPOSE: The management of malignant pleural effusions is often complex and no single strategy is universally effective. Indwelling pleural catheters are considered with poor performance status or trapped lung, but are prone to infection. For example, the PleurX catheter is reported to have an empyema rate of 3.2%. An alternative is a tunneled pleural catheter drained through a subcutaneously implanted access port (PleuralPort).
METHODS: Case series of eight PleuralPorts placed in seven patients with malignant effusions.
RESULTS: All PleuralPorts were placed under conscious sedation without complication. Two catheters clotted requiring instillation of TPA. Two patients with nonsmall cell lung cancer achieved spontaneous pleurodesis. A third patient with nonsmall cell lung cancer continues to be drained by hospice. Two patients with breast cancer have had limited time for follow-up. One patient with lymphoma drained over 1000 ml three times a week and was referred for thoracoscopic pleurodesis. One patient with primary peritoneal carcinomatosis continues to be drained. There were no access or infectious complications.
CONCLUSION: PleuralPorts appear to be a practical and safe alternative to externalized pleural catheters. They can be placed in the outpatient setting under conscious sedation with a short recovery time, allowing for minimal interruption of treatment.
CLINICAL IMPLICATIONS: PleuralPorts offer the potential for reduced infection compared to externalized pleural catheters and may be a particularly good alternative for patients receiving chemotherapy. Although no specific drainage kit is commercially available, the supplies are readily available for use in the hospital, by home health nursing or hospice at a substantial cost savings compared to the PleurX catheter. PleuralPorts create the potential for intrapleural chemotherapy.
DISCLOSURE: Ken Yoneda, No Financial Disclosure Information; No Product/Research Disclosure Information