PURPOSE: Malignant pleural effusion (MPE) is a pre-morbid condition causing significant dyspnea and impairing quality of life. Historically, symptomatic MPEs were treated with repeated thoracentesis, risking potential complications, including pneumothorax, empyema, pain and bleeding, with each attempt. Pleur-X catheters are a cost-effective and safe alternative treatment. Others describe placing Pleur-X catheters in the operating room, clinic using special procedure rooms or with radiology guidance. This report describes placing Pleur-X catheters as a bedside procedure.
METHODS: Patients are referred to Thoracic Surgery for evaluation and treatment. Chest radiographs, including right and left lateral decubitus views, are obtained. Patients with loculated MPEs with limited life-expectancy are offered bedside placement of Pleur-X catheter rather than thoracoscopic attempts at decortication. Once admitted, nursing staff teach patient and family about use and care of the catheter, including an instructional video. Pleur-X cathether is placed using local anesthesia and moderate sedation at the bedside. Once the family demonstrates proper drainage and dressing techniques, the patient is discharged home.
RESULTS: 46 consecutive patients have undergone bedside placement of Pleur-X catheter between January 2003 and March 2006. Patients admitted for reasons other than treatment of MPE were excluded from analysis. Median length of stay, following catheter placement, was 1 day. Median charges for procedure and hospitalization were $3900.00. There were no deaths or major complications associated with catheter placement; specifically there were no catheter-related infection, bleeding or pneumothorax or readmissions.
CONCLUSION: Bedside placement of Pleur-X catheter for treatment of MPE is cost-effective, associated with low risk of morbidity and is patient- and family-friendly. In-patient admission allows for a coordinated approach to management of MPE including appropriate comprehensive nursing education to patient and family which allows safe and prompt discharge of patient.
CLINICAL IMPLICATIONS: A coordinated approach to management of MPE using Pleur-X catheter placed as a bedside procedure is a cost-effective and patient friendly means of palliation compared to repeat thoracentesis. Patients have significant relief of symptoms without enduring multiple procedures and visits to the hospital.
DISCLOSURE: Katie Nason, None.