What are the indications for a tunneled pleural catheter (TPC)?

From the Guidelines

Tunneled pleural catheters are primarily indicated for the management of recurrent, symptomatic malignant pleural effusions with expandable lung, as well as those with nonexpandable lung, failed pleurodesis, or loculated effusion, as suggested by the American Thoracic Society and the Society of Thoracic Surgeons 1. The indications for tunneled pleural catheters can be broken down into several key areas, including:

• Recurrent, symptomatic malignant pleural effusions with expandable lung, where the lung can fully expand after fluid drainage, making pleurodesis a viable option, but a tunneled pleural catheter may be preferred for symptom management and quality of life improvement 1
• Malignant pleural effusions with nonexpandable lung, where the lung cannot fully expand after fluid drainage, making pleurodesis ineffective, and a tunneled pleural catheter is the preferred option for palliation of dyspnea 1
• Failed pleurodesis or loculated effusion, where a tunneled pleural catheter can provide effective symptom relief and improve quality of life 1
• Recurrent benign effusions, such as those from heart failure or hepatic hydrothorax, that are refractory to medical management, and situations where pleurodesis is contraindicated or has failed 1 The procedure for inserting a tunneled pleural catheter involves placing a silicone catheter through a subcutaneous tunnel into the pleural space, which can be performed under local anesthesia with minimal sedation, making it suitable for patients who cannot tolerate more invasive procedures 1. The benefits of tunneled pleural catheters include effective symptom relief, improvement in quality of life, and reduction in healthcare utilization, with a low rate of major complications, such as empyema and cellulitis, and a low rate of catheter removal due to complications 1.

From the Research

Indications for Tunneled Pleural Catheter

The indications for a tunneled pleural catheter include:

• Recurrent malignant pleural effusion (MPE) 2, 3
• Recurrent nonmalignant pleural effusions refractory to maximal medical therapy 4
• Patients with a trapped lung in diagnostic VATS procedure 2
• Patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis 2
• Patients in a reduced condition with a limited lifespan due to underlying disease 2
• Patients with hematologic malignancy and recurrent, symptomatic pleural effusion 5

Patient Selection

Patient selection for tunneled pleural catheter placement should be based on individual patient characteristics, including:

• Symptomatic pleural effusion
• Failed pleurodesis
• Trapped lung
• Limited lifespan due to underlying disease
• Refractory to maximal medical therapy

Clinical Outcomes

Clinical outcomes for patients with tunneled pleural catheters include:

• Relief of dyspnea
• Spontaneous pleurodesis
• Low rate of complications, such as pleura empyema, accidental dislodgement, and malfunction of the drainage 2, 3, 5