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When should an indwelling pleural catheter be considered for malignant pleural effusion?

Abdul Hamid Alraiyes, MD, FCCP, Kassem Harris, MD, FCCP and Thomas R. Gildea, MD, MS, FCCP
Cleveland Clinic Journal of Medicine December 2016, 83 (12) 891-894; DOI: https://doi.org/10.3949/ccjm.83a.15075

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    Draining of a pleural effusion in the left hemithorax. The indwelling pleural catheter is tunneled under the soft tissue and enters the thoracic cavity between the ribs. Proximally, the catheter has a one-way valve and evacuates into a negative-pressure bottle.

  • FIGURE 2
    FIGURE 2

    Tunneling the indwelling pleural catheter under the soft tissue of the chest wall before insertion in the pleural cavity. The procedure can be performed at the bedside under sterile conditions. The site of the insertion is identified with thoracic ultrasonography. (A), The guide wire is inserted at the thoracic inlet area, then (b) the catheter is tunneled under the skin to the guide wire area for insertion.

  • FIGURE 3
    FIGURE 3

    Computed tomography of the chest demonstrates (A) left malignant pleural effusion secondary to adenocarcinoma of the lung, and (B) trapped lung (black arrow) after placement of an indwelling pleural catheter (white arrow) in the same patient.

Tables

  • TABLE 1

    Management of malignant pleural effusions

    ProcedureIndication
    Repeated thoracentesisFirst presentation with pleural effusion
    Chest tube drainage and talc pleurodesisMassive pleural effusion, empyema, and history of poor compliance
    Medical or surgical thoracoscopy and talc poudrageHospitalized patient with history of poor compliance
    Pleurectomy and decorticationMesothelioma
    Indwelling pleural catheterOutpatient recurrent malignant pleural effusion with respiratory symptoms
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