NEW SOLUTION IN PLEURAL EFFUSION MANAGEMENT CASE REPORT

Authors:Valerian Cristian PavaloiuVlad PopescuOlga DanailaCristian Paleru

Marius Nasta National Institute of PneumologyNEW SOLUTION IN PLEURAL EFFUSION MANAGEMENT CASE REPORT

PurposeFinding new solution for pleural effusion management

Reducing apparition of complications

Improving patients comfort

IntroductionDevelopment of a malignant pleural effusion is associated with a very poor prognosis, with median survival of 4 months and mean survival of less than 1 year. Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest. Jan 2000;117(1):73-8

Effusions from cancers that are more responsive to chemotherapy, such as lymphoma or breast cancer, are more likely to be associated with prolonged survival, compared with those from lung cancer or mesothelioma. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. Aug 2010;65 Suppl 2:ii32-40.

Case DescriptionMale, caucasian, 75 years old

Dyspnea, cough, right anterior thoracic pain, 2kg weight loss in past 7 days

Coronary heart disease, Hypertension, atrio-ventricle block gr I

Admission Rx

SaO2=92%Evacuatory thoracocentesis is performed until patient started to cough. 2000 ml sero-hemorrhagic fluid is evacuated

First day follow upSaO2=94%

Exploratory ThoracoscopyParietal pleuraVisceral Pleura

Another 2000ml of sero-hemorrhagic fluid was evacuated

Chemical Pleurodesis

First day post-op RX

Patient drainage for the next few dayswas 1000 ml/24h

Hystopatological result demonstrated an malignpleural effusion as both pleurae were infiltrated.

CT scan

Reveals post right pleural effusion status partially evacuated surgical antero-lateral right basal chest pneumothorax and underlying lung collapse. Bilateral bronchiectasis. Bilateral diffuse interstitial pulmonary infiltration. Bilateral lung microemphysema.

Rx post PleurX

10 days post op we decide to remove our drainage tube and insert PleurX catheter to try to avoid Infection and achieve pleurodesis.

First drainage on PleurX was 800 ml/24h.

PleurX

1. Vacuum bottleActive vacuum technologydrains quickly and comfortablywithout the need for gravity.Bottles are available in 500 mLand 1,000 mL sizes.2. Patented safety valveHelps prevent inadvertent passageof air or fluid through the catheter.3. Polyester cuffPromotes tissue ingrowth to helpreduce infection risk and hold thecatheter securely in place.4. 15.5 Fr silicone catheterSoft and flexible, conforms tothe pleural andminimizes insertion-site discomfort.5. Beveled fenestrationsLarge, smooth fenestrations withbeveled edges promote drainageand help avoid occlusions.12345

Patient discharge

Next day after PleurX catheter insertion patient was discharged (SaO2=95%)

No infections were revealed

Patient was educated to sterily connect his vacuum when needed (48 h or progresive dyspnea)

PleurX KitPleurX patient starter kit, 1000 mL $265

PleurX patient starter kit, 500 mL $265

PleurX pleural catheter kit $550

Each kit includes: Four PleurX vacuum drainage kits

OthersWarren WH, Kalimi R, Khodadadian LM, Kim AW.Management of malignant pleural effusions using the PleurX catheter. Ann Thorac Surg. 2008 Mar; 85(3):1049-55.Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA

231 PleurX catheters placed at 202 patients with symptomatic malignant pleural effusion. 58% removed after drainaged stoped 3,8% reacumulation of fluid 2.2% infection (most cellulitis at the insertion site) 4.8% blockage

Why choose the PleurX catheterfor your patients?Clinically proven

More than 15 years of clinical use

Outcomes published in more than 30 clinical journal articles

Multi-specialty utilization (oncology, thoracic surgery, pulmonology/interventional pulmonology, interventional radiology)

Why choose the PleurX catheterfor your patients?Positive outcomes Spontaneous pleurodesis in up to 70%

Rapid symptom relief

Low infection rates (less than 3%)1,3,4

Helps eliminate the need for hospital visits for repeat thoracentesis

Why choose the PleurX catheterfor your patients?Easy to use and well accepted

Patients can control their own drainage at home Catheter placement usually performed as an outpatient procedure Active vacuum technology is safe, comfortable and quick Can be utilized by home health and hospice Extensive patient education materials available

THANK YOU

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