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Disorders of the Pleura |

Safety and Efficacy of Fibrinolytic Therapy in Restoring Function of an Obstructed Tunneled Pleural Catheter

Candice Wilshire; Brian Louie; Ralph Aye; Alexander Farivar; Eric Vallières; Jed Gorden
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Swedish Cancer Institute and Medical Center, Seattle, WA


Chest. 2014;146(4_MeetingAbstracts):437A. doi:10.1378/chest.1995003
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Abstract

SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Tunneled pleural catheters (TPCs) have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the TPC is rare; however, when obstructed the catheter fails to achieve its primary goal. Management of TPC obstruction is not well described. We aim to determine if the use intracatheter fibrinolytic therapy is safe and effective in restoring catheter function.

METHODS: Seventeen of 125 patients with TPC (PleurX®) for a pleural effusion between 2009-2014 received fibrinolytic therapy for catheter obstruction. Alteplase was instilled using a PleurX® catheter access kit or lockable drainage line in doses ranging from 2-10 mg and allowed to sit in the catheter for 60 minutes. An obstructed catheter was defined by a sudden reduction to <10 mls in pleural fluid drainage with fluid visualized in the thorax on ultrasound or radiography. Effective catheter clearance was defined as resumption of adequate pleural fluid drainage to >10 mls. Results are median values with IQR, unless otherwise stated.

RESULTS: Obstruction occurred in 17 TPCs. Etiology of pleural effusion included: 12 malignant pleural effusions, 3 para-malignant effusions, 1 chylothorax and 1 hepatic hydrothorax. One hundred percent (17/17) of obstructed TPCs resumed drainage following fibrinolytic instillation, post-lytic drainage was 300 (150-500) mls. No associated complications or adverse reactions were recorded following alteplase installation or drainage. The time from TPC insertion to obstruction was 2 (1-3) months. Forty-seven percent (8/17) of TPCs experienced more than one obstructive episode (2, 2-3). All recurrent obstructions occurred within the range of 2-90 days of the previous episode. Time to pleurodesis from last fibrinolytic therapy was 2 (1-2) months. Forty-four percent (14/32) of the procedures were performed in an outpatient setting.

CONCLUSIONS: Fibrinolytic instillation through a TPC to restore function of an obstructed catheter is safe and effective as evidenced by the lack of complications and success in achieving catheter patency. The procedure can also be performed safely in an outpatient setting.

CLINICAL IMPLICATIONS: TPCs are increasingly utilized in the management algorithm for recurrent symptomatic pleural effusions. An obstructed TPC is of no clinical benefit in managing a patient’s symptoms. This study gives the clinician a safe and effective tool to easily treat a TPC obstruction without catheter removal or mechanical instrumentation in an outpatient setting.

DISCLOSURE: The following authors have nothing to disclose: Candice Wilshire, Brian Louie, Ralph Aye, Alexander Farivar, Eric Vallières, Jed Gorden

Tunneled Pleural Catheters (TPCs) are FDA approved for drainage of the pleural space. Our study investigated the use of thrombolytic therapy to clear a blockage in TPCs. All TPCs placed at our institution are PleurX catheters. There are currently no studies or indications for instillation through a TPC. The safety and efficacy is the primary aim of this research. This submission is primary investigator research addressing a specific focal question.


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