Consensus-based standardization of procedural steps for indwelling pleural catheter placement: a modified Delphi...

Indwelling pleural catheters (IPCs) are commonly used for managing recurrent pleural effusion, yet standardized techniques for their placement are lacking. This study aimed to establish a consensus on IPC placement technique through a modified Delphi method.

A three-round online-based survey was conducted among 22 experienced interventional pulmonologists in the United States. Consensus development involved identifying procedural domains from established interventional pulmonology curricula, refined into modules on pre-procedure preparation, technique, and post-procedure care. The survey included demographics, IPC placement preferences, and evaluation of procedural steps. Consensus was defined as an average numerical rating score ≥4 out of 5.

Sixteen physicians completed all three survey rounds. Consensus was achieved on various aspects including pre-procedure preparation, choice of site, sterile preparation, Seldinger technique, tunneling, catheter insertion, securing catheter, and post-procedure care. There were divergences in the routine use of prophylactic antibiotics and screening of intercostal artery using linear ultrasound with doppler. The proposed steps encompass comprehensive IPC placement guidelines.

This study presents a standardized approach for IPC placement derived from expert consensus, addressing variability in practice and promoting procedural safety. These guidelines serve as a foundation for future research and practice refinement in IPC placement.