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Semin Respir Crit Care Med 2023; 44(04): 454-461
DOI: 10.1055/s-0043-1769093
Review Article

Indwelling Pleural Catheter: Management of Complications

Calvin Sidhu
1   Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
2   School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
3   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
,
Helen E. Davies
4   Department of Respiratory Medicine, University Hospital of Wales, Cardiff, United Kingdom
,
Sanjeevan Muruganandan
5   Department of Respiratory Medicine, Northern Health, Melbourne, Australia
6   Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
,
Macy M. S. Lui
7   Division of Respiratory Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
,
Estee P. M. Lau
1   Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
2   School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
,
Y. C. Gary Lee
1   Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
3   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
8   School of Medicine, University of Western Australia, Perth, Australia
› Author Affiliations Funding Y.C.G.L. is a recipient of a Practitioner Fellowship from the Medical Research Future Fund of Australia.
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Abstract

Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.

Keywords

indwelling catheter - pleural - complications


Publication History

Article published online:
31 May 2023

© 2023. Thieme. All rights reserved.

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