Chest
Volume 141, Issue 4, April 2012, Pages 1090-1094
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Selected Reports
Fractured Indwelling Pleural Catheters

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Indwelling pleural catheters (IPCs) are increasingly used in the management of malignant pleural effusions. IPCs are designed to be secured in situ indefinitely; however, in selected patients, IPCs can be removed when drainage ceases. This case series reports complications of removal of IPCs that resulted in fractured catheters or necessitated deliberate severing of the catheters. From the combined data of two pleural centers, 61 of 170 IPCs inserted (35.9%) were removed. In six cases (9.8%), the removals were complicated, leading to fracture or iatrogenic severing of the IPC. Although four patients had catheter fragments retained within the pleural space, none developed any complications (eg, pain or infection) (median follow-up, 459 days; range, 113-1,119 days), despite two patients undergoing subsequent chemotherapy. Clinicians should be aware that IPC removal can be problematic, but retained fragments are safe, and aggressive retrieval is unnecessary.

Section snippets

Materials and Methods

The pleural units at the Churchill Hospital, Oxford, England, and Sir Charles Gairdner Hospital in Perth, Western Australia, Australia, are specialist pleural centers active in using IPCs in pleural effusion management. Both units prospectively record in their clinical databases all patients who received an IPC, their complications, and their outcomes as approved by the local ethics committees.

Of the 170 IPCs inserted in the Oxford (n =122 in 58 months) and Perth (n =48 in 18 months) units, 61

Case 1

An 81-year-old man with a history of multiple malignancies, including squamous cell carcinoma of the left lung treated with radical radiotherapy 2 years before and previous colorectal, prostate, and bladder cancers, was referred for management of left-sided pleural effusion. He had a trapped lung and recurrent exudative cytology-negative effusions requiring frequent thoracenteses for symptomatic relief. In view of his age and comorbidity, the patient declined further investigations of the

Discussion

We report on six cases in which IPC removal was complicated by fracture of the catheter, by the need to sever it after failed attempts to remove the IPC en bloc, or both (Table 1). Although a relatively new device, IPC has been adopted rapidly in the clinical management of malignant pleural effusions. New insights into its practical management are gained as the clinical experience of the use of IPCs increases. This series illustrates that removal of IPCs either can be complicated by fracture of

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Drs Lee and Rahman are investigators for the TIME-2 study funded by the British Lung Foundation. The IPCs used in the study were provided without charge by Rocket Medical plc. None of the investigators received personal benefits from the study. Dr Lee has received an honorarium from CareFusion Corporation. Dr Rahman has provided consultancy services for Rocket Medical plc. Drs Fysh and

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Funding/Support: The authors received research funding from the State Health Research Advisory Council of the Western Australian Health Department (to Dr Lee), the Sir Charles Gairdner Hospital project grants (to Drs Lee and Fysh), the Raine Foundation (to Dr Lee), the National Health Medical Research Council (to Drs Lee and Fysh), the University Postgraduate Award of the University of Western Australia (to Dr Fysh), the Oxford NIHR Biomedical Research Centre (to Drs Wrightson and Rahman), and the UK Medical Research Council (to Dr Rahman).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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