Outpatient pleurodeses of malignant pleural effusions using a small bore pigtail catheter

Purpose: To demonstrate the feasibility of ambulatory drainage and sclerosis using a small bore pigtail catheter in patients with malignant pleural effusions. Methods: A 14-F pigtail catheter was percutaneously inserted into the pleural space in our outpatient office and connected to a closed gravity drainage bag system. The patient were instructed in the use of the drainage system and discharged to return for sclerosis with 4 grams of talc after the drainage slowed to less then 100 ml/24 hours. Each patient was graded for dyspnea and performances status using the Eastern Cooperative Oncology Group score (ECOG) and Baseline and Transitional Dyspnea Index score (BDI-TDI) prior to pigtail placement and again at 30 days. Radiographic response was graded as total response, partial response, or failure. Results: Ten women, ages 41-79 were enrolled. Chest tubes remained in place 3-10 days and drained 1685-6050 ml. Two patients were unable to be sclerosed. In one case the catheter fell out In the other there was only minimal drainage and chest CT revealed a large lung mass. Of the remaining 8 patients, 6 reported symptomatic improvement at 30 days. One with a prior history of a lobectomy was found to have a chylous effusion and went on to developed a hydropneumothorax. Sclerosis was unsuccessful. One died in hospital on day 26 post sclerosis despite radiographic resolution. Four of 6 improved on TDI and follow-up ECOG score . Three had complete and one partial resolution on chest radiograph. Two could not complete TDI because they were not ambulatory for other reasons. Conclusions: Of 10 patients 8 were sclerosed, 7 improved symptomatically and 6 had no recurrence of effusion. However only 4 returned to ambulatory status with complete x-ray clearing at one month. This was generally due to progression of the underlying malignancy. Hospitalization was necessary only in one case. Further studies should compare outcomes with between this method and conventional treatment with large bore chest tubes. Clinical Implications: Ambulatory sclerosis of malignant effusion using a small bore catheter is a feasible alternative to inpatient sclerosis with a large bore chest tube.