Chest
Selected ReportsFractured Indwelling Pleural Catheters
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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Cited by (39)
Indwelling Pleural Catheters
2021, Encyclopedia of Respiratory Medicine, Second EditionManagement of Malignant Pleural Effusions
2020, Clinics in Chest MedicineCitation Excerpt :Catheter removal can be complicated by either a fracture of the catheter or a need for iatrogenic severing in a minority of cases, sometimes making retrieval of all fragments challenging.56 One case series of 4 patients found no complications from retained catheter fragments during follow-up (median follow-up duration, 459 days), including among the 2 patients undergoing chemotherapy, suggesting that aggressive attempts to remove catheter fragments may not be necessary.57 Box 4 addresses various questions about IPCs that are commonly encountered in clinical practice.
Novel complications of the tunnelled indwelling pleural catheter
2020, PulmonologyCitation Excerpt :Catheter related pleural effusions were further sub divided into cellulitis, empyema and tunnel infections.9 Fysh et al reported complications in 9.8% cases of TIPC removal leading to fracture or iatrogenic severing and four patients having catheter fragments retained within the pleural space without any complications.10 Grosu et al describe the various reasons for fractures of TIPC such as, greater than 1 cm placement of the catheter cuff within the tunnel, longer than 5 cm subcutaneous tract, catheter tract metastasis, mesothelioma and changes in the manufacturing process of the catheters.2
Malignant pleural disease
2023, BreatheIndwelling Pleural Catheter: Management of Complications
2023, Seminars in Respiratory and Critical Care Medicine
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).
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