A single institution experience for the management of recurrent pleural effusions with tunneled pleural catheter and its evolution

Background: Indwelling tunneled pleural catheters (TPCs) are increasingly being used to treat recurrent pleural effusions. There is also an increased interest in early pleurodesis in order to prevent infectious complications. We studied the time to removal and other outcomes for all the TPCs placed at our institution. Methods: After institutional review board approval, records of patients who had had a TPC placed between July 2009 and June 2016 were reviewed; the catheters were placed in an endoscopy suite or during pleuroscopy with or without a sclerosant. The catheters were drained daily or less frequently and were removed after three drainages of less than 50 ml. Results: During the study period 193 TPCs were placed. Of these 45 (23%) were placed for benign diseases. The commonest malignancy was lung cancer 70 (36%). Drainage 2-3 times a week without a sclerosant (n = 100) lead to pleurodesis at 57 78 days, while daily drainage after TPC + pleuroscopy + talc (n = 41) achieved the same result in 14 +/- 8 days (p < 0.001). TPC + talc + daily protocol achieved pleurodesis in 19 +/- 7 days, TPC + rapid protocol achieved the same result in 28 +/- 19 days (p = 0.013). The TPCs + sclerosant had an odds ratio of 6.01 (95% confidence interval: 2.1-17.2) of having a complication versus TPC without sclerosant. Conclusions: It is clear that TPCs when placed with a sclerosant had a significantly shorter dwell time; However, they were associated with higher odds of complications. One must be aware of these possibilities when offering what is essentially a palliative therapy.