The Untapped Potential of Tunneled Pleural Catheters

Tunneled pleural catheters (TPCs) are routinely used for outpatient drainage of malignant pleural effusions, although use in recurrent pleural effusions resulting from nonmalignant conditions requires further evaluation. We hypothesized that TPCs could decrease inpatient admission rates for exacerbations of nonmalignant pleural effusions.

A retrospective chart review was done of patients with TPCs inserted for recurrent nonmalignant pleural effusions. Patients were set up with home care nursing support and catheter draining two to three times per week and were then followed on an outpatient basis until spontaneous pleurodesis and catheter removal. Data collection included demographics, comorbidities, and hospital admission rates relative to TPC placement as well as removal.

Thirty-seven patients with recurrent, nonmalignant pleural effusions were enrolled (17 female and 20 male patients). Patients had comorbid conditions including hypertension (86%), chronic kidney disease (59%), congestive heart failure (67%), liver disease (11%), and malnutrition (22%), and most patients (89%) had multiples of these conditions. Total admissions for pleural effusion exacerbations decreased from 59 to 15 in the 1 year before and after TPC placement and from 42 to 6 in the respective 3-month periods (p < 0.0001). Six of the 37 patients still had TPCs in place; for the remaining 31 patients, admissions decreased from 60 to 9 in the 1-year periods before and after TPC removal and from 33 to 2 in the respective 3-month periods (p < 0.0001); no patients required subsequent pleural interventions.

The study results support TPC placement in recurrent nonmalignant pleural effusions refractory to medical management as an effective and plausible management option.