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Indwelling pleural catheters (IPCs) are commonly used in the management of malignant pleural effusion (MPE). There is little data on their use in non-malignant conditions. All IPC insertions for non-malignant cases from five large UK centres were found using prospectively maintained databases. Data were collected on 57 IPC insertions. The commonest indications were hepatic hydrothorax (33%) and inflammatory pleuritis (26%). The mean weekly fluid output was 2.8 L (SD 2.52). 48/57 (84%) patients had no complications. Suspected pleural infection was documented in 2 (3.5%) cases. 33% (19/57) of patients underwent 'spontaneous' pleurodesis at a median time of 71 days. Patients with hepatic disease achieved pleurodesis significantly less often than those with non-hepatic disease (p=0.03). These data support the use of IPCs in select cases of non-malignant disease when maximal medical therapy has failed.

Background Recurrent symptomatic non-infectious pleural effusions can be effectively treated with MT and TP with pleurodesis rates approaching 85% in variety of malignant and benign aetiologies. When TL is likely at MT, management is uncertain. Aim We report on a single centre experience of inserting an IPC at MT with or without talc poudrage for suspected trapped lung. TL was suspected if any of the following were observed (a) failure of lung to inflate on voluntary coughing at MT, (b) visceral involvement of more than 25%, (c) radiological evidence of endobronchial compromise and (d) hydropneumothorax following previous thoracocentesis. Method A review of all IPC insertions at MT performed at our institution between March 2009 and Feb 2013 assessing indications, length of stay (LoS) after procedure, use of concurrent TP, IPC removal rates and recorded complications. All cases had been performed using rigid thoracoscopy. TP was performed with 4g sterile graded talc. Rocket 16F IPC were used in all cases. Results All IPCs were inserted during MT for likely or possible TL. N = 36cases. 14 male. Diagnoses–10 benign recurrent effusions; 26 malignant. See table 1 for details. Median age 73yrs (45–92). Median LoS post procedure–non-elective 7 days (1–23); elective 2.5 days (0–6). 22 (56%) had concurrent TP (18 for malignancy). 14 (36%) had their IPC removed with median time to removal 40 days (28–119) and of these, 11 had received TP during MT. 20 patients have died during follow up (none procedure-related) of which 11 still had their IPC in situ . Complications–2 blocked drains (not talc group, 1 case needing additional thoracocentesis), 2 leaking caps (replaced). Discussion IPC insertion at MT with or without TP for cases of suspected TL appears to be safe, effective and obviates the need for further pleural intervention at a later date. This potentially has significant benefits to the patient as well as a reduction in overall healthcare costs to the NHS. Using the above criteria predicted TL in 78% of patients. This single centre observation needs to be investigated by a larger multi-centre study in patients with suspected TL at MT.

Although indwelling pleural catheters (IPC) are commonly used to allow the outpatient management of malignant pleural effusions, an increasing number if IPCs are being inserted to control effusions caused by non-malignant processes. This is the first UK-based series to analyse the use of IPCs in this setting. Methods We analysed data from 3 UK hospitals with large pleural services. IPCs inserted between 2007 and June 2012 were identified retrospectively. Information was obtained from hospital records and from patients’ primary physicians. Bilateral or non-sequential IPCs in a single patient were treated as separate data points. Results 30 IPCs were inserted, with a year-on-year rise in the number of drains seen over the analysis period. The mean age of patients was 64 (range 37–92 years). 57% were male. IPCs stayed in place for a median of 95 days (IQR 41–211) before death or removal. 6 patients died with their IPC in situ. The majority of drains (47%, n=14) were inserted for the management of hepatic hydrothorax of varying aetiology (see table 1). 10 of these patients were given human albumin solution (HAS) intermittently with drainage. 87% of patients began with a drainage frequency of 3 times per week or greater. At final analysis only 37% of patients remained in this group, with 50% overall experiencing a reduction in drainage needs. Drainages were most often performed by community nurses (30%) or family members (30%). Complications included drain site leak (n=1), equipment failure (n=1), pleural infection (n=2) and skin infection (n=1). IPCs were removed in 54% (n=16), with 6 patients achieving successful pleurodesis. Other reasons for removal included fluid loculation (n=2), or transplant operation(n=3). 83% of patients needed no additional pleural intervention following IPC insertion. In only 1 case did the primary physician feel the insertion of the IPC was not of value. Conclusions These data suggest the use of IPCs in the non-malignant setting is increasing. Complications were rare and most patients could be managed for extended periods in the community alone. This series would suggest that IPCs are a viable option for the management of recurrent pleural effusions of non-malignant aetiology. Dr Maskell has received an unrestricted research grant from Care Fusion, not related to this study. Dr Rahman acts as a consultant to Rocket Medical UK, not related to this study.