Management of Indwelling Tunneled Pleural Catheters: A Modified Delphi Consensus Statement
Christopher R Gilbert1, Momen M Wahidi2, Richard W Light3
1Department of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
Chest
|June 21, 2020
Summary
Managing indwelling tunneled pleural catheters (IPC) for recurrent pleural effusions is complex. This expert consensus provides guidance on IPC care, addressing infections and malfunctions, but highlights areas needing further research.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Recurrent pleural effusions pose management challenges for clinicians.
- Indwelling tunneled pleural catheters (IPC) are increasingly used for their effectiveness and ease of outpatient placement.
- Complications, particularly infections, are rising with increased IPC use, yet post-placement management guidance is minimal.
Purpose of the Study:
- To develop clinical consensus statements for perioperative and long-term management of indwelling tunneled pleural catheters (IPC).
- To address key issues in IPC use based on expert opinion in pleural disease management.
Main Methods:
- A modified Delphi process involving 25 international physicians from various specialties.
- Consensus statements were formulated through meetings and anonymous online surveys.
- Consensus was defined as >80% agreement among panel members.
Main Results:
- Strong consensus was achieved on 36 statements covering IPC infection definition, management of infectious complications, prevention strategies, obstruction/malfunction management, removal assessment, and patient/caregiver instructions.
- No consensus was reached on 29 statements, indicating areas of ongoing debate or insufficient evidence.
Conclusions:
- Management of recurrent pleural disease using IPC is complex.
- The consensus statements offer guidance on various IPC management aspects, identifying knowledge gaps.
- Further research into the long-term management of IPC is warranted.
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