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Correspondence |

Complications of Removal of Indwelling Pleural CathetersFractured Pleural Catheters FREE TO VIEW

Horiana B. Grosu, MD; Georgie A. Eapen, MD, FCCP; Rodolfo C. Morice, MD, FCCP; David Ost, MD; Lara Bashoura, MD, FCCP; Saadia Faiz, MD, FCCP; Carlos A. Jimenez, MD, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.

Correspondence to: Carlos A. Jimenez, MD, FCCP, 1400 Hermann Pressler Dr, Unit 1462, Houston, TX 77030-4008; e-mail: cajimenez@mdanderson.org


Financial/nonfinancial disclosures: Dr Eapen provides consulting services to Olympus Corp and PENTAX Medical Co. Dr Jimenez is investigator for the Intrapleural Catheter Daily Versus Three Times a Week Drainage Study (NCT00761618) funded by CareFusion Corp.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):1071. doi:10.1378/chest.12-1078
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Published online

To the Editor:

We read with interest the article published by Fysh et al1 in CHEST (April 2012) describing a high incidence (10%) of fractured, indwelling, pleural catheters (IPCs) and would like to comment on the much lower incidence of this complication as it is reported in the literature and in our experience with IPCs. Our review of seven publications on the subject, including a systemic review by Van Meter et al2 comprising almost 2,000 IPCs, described only one case of a fractured IPC in a patient with mesothelioma and trapped lung.3 In a review of our institutional database, we identified only two fractured catheters out of 1,790 IPCs that we placed since 1998.

While the cause of this significant discrepancy in the rate of catheter fracture between the authors’ experience and ours is unclear, we would like to highlight several factors that could contribute to the variance:

  • 1. Placement of the polyester cuff within 1 cm of the tunnel entry site is crucial to facilitate catheter removal. More distant placement of the catheter cuff within the tunnel leads to difficulties in dissecting the fibrous adhesions from the cuff and increases the risk of severing or weakening the catheter.

  • 2. The length of the subcutaneous tract ideally should be kept at 5 cm. Longer subcutaneous tracts may result in catheter fenestrations located outside the pleural cavity, within the chest wall or subcutaneous tissue, permitting tissue ingrowth and impeding removal.

  • 3. Catheter tract metastasis associated with IPC and mesothelioma that may lead to catheter damage or tumor ingrowth in the catheter has been reported.4 Fifty percent of patients with fractured catheters in this article had mesothelioma. Even though the number is too small to draw any conclusions, further research may be warranted.

  • 4. Changes in the manufacturing process can cause structural failure of the catheters.

We had an experience related to defective polyester cuffs (PleurX catheter; CareFusion Corp), which caused a high number of IPC complications. Once the company was notified, changes were made, and subsequently we were able to demonstrate a reduction in the complication rates.5

Fysh ETH, Wrightson JM, Lee YCG, Rahman NM. Fractured indwelling pleural catheters. Chest. 2012;141(4):1090-1094. [PubMed] [CrossRef]
 
Van Meter MEM, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-76.
 
Pien GW, Gant MJ, Washam CL, Sterman DL. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest. 2001;119(6):1641-1646.
 
Janes SM, Rahman NM, Davies RJO, Lee G. Catheter-tract metastases associated with chronic indwelling pleural catheters. Chest. 2007;131(4):1232-1234.
 
Casal RF, Bashoura L, Ost D, et al. Detecting medical device complications: lessons from an indwelling pleural catheter clinic. Am J Med Qual. In press.. .
 

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References

Fysh ETH, Wrightson JM, Lee YCG, Rahman NM. Fractured indwelling pleural catheters. Chest. 2012;141(4):1090-1094. [PubMed] [CrossRef]
 
Van Meter MEM, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-76.
 
Pien GW, Gant MJ, Washam CL, Sterman DL. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest. 2001;119(6):1641-1646.
 
Janes SM, Rahman NM, Davies RJO, Lee G. Catheter-tract metastases associated with chronic indwelling pleural catheters. Chest. 2007;131(4):1232-1234.
 
Casal RF, Bashoura L, Ost D, et al. Detecting medical device complications: lessons from an indwelling pleural catheter clinic. Am J Med Qual. In press.. .
 
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