Bronchogenic carcinoma contributes to approximately one third of malignant pleural effusions, followed by breast cancer and lymphoma. Chronic tunneled intrapleural catheters are effective in the management of recurrent malignant effusions, significantly reducing symptoms with minimal patient discomfort and decreased length of hospital stay. The Pleurx® catheter is usually placed into the pleural space using the Seldinger technique by inserting a dilator with a peel-away sheath over a wire. This step is the most difficult. The catheter is fed through the sheath and the sheath is peeled away. We report a simpler option.
We describe our experience using a modified technique for placement of the 16 catheters in 13 patients (eight as a primary procedure, eight as part of a thoracoscopy, 3 repeats). All but 2 had trapped lung. All patients had symptomatic malignant pleural effusions and the catheter was placed for palliation. Technique: Entry site is identified; sterile preparation and local lidocaine are used. 2 cm skin incisions are made 5cm apart. The catheter is inserted directly into the pleural space using forceps after tunneling between incisions without the need for a guide wire or dilator sheath. Suction of pleural contents confirms position. Anchoring and postoperative care are not changed.
All patients had immediate relief of symptoms and catheters were placed where desired. There were no early or late complications. Catheters were removed when drainage ceased (1 removed by an ER practitioner unfamiliar with its function). Repeat catheters were placed for later occurring symptomatic effusions or in alternate large loculated spaces.
This modified technique is simple, safe and we believe more efficient when performed by physicians trained for chest tubes and minimally invasive procedures. It is easy to learn, eliminates the introducer step, allows targeting of smaller, narrower, or oddly shaped spaces and does not increase the rate of complications.
This modified technique may improve efficiency and widen the range of practitioners who safely and comfortably perform this important palliative procedure.
Maria Cirino, None.