From the Guidelines
A tunneled pleural catheter (TPC) and a thoracostomy tube are two different medical devices used to manage pleural effusions, with the main difference being that a TPC is a long-term, indwelling catheter that allows for repeated drainage of fluid from the pleural space, whereas a thoracostomy tube is typically used for short-term drainage and may require repeated insertions.
Key Differences
- Insertion technique: A TPC is inserted using a tunneled technique, which involves creating a subcutaneous tunnel for the catheter to reduce the risk of infection and promote stability [ 1 ]. In contrast, a thoracostomy tube is typically inserted using a simpler technique.
- Duration of use: TPCs are designed for long-term use, with some studies reporting a median duration of 52 days [ 1 ], whereas thoracostomy tubes are usually removed after a short period of time.
- Complications: The complication rates for TPCs and thoracostomy tubes differ, with TPCs having a lower rate of major complications, such as empyema and cellulitis, which were reported to be 2.8% and 3.4%, respectively [ 1 ].
Indications for Use
- Symptomatic recurrent malignant pleural effusions: TPCs are recommended for patients with symptomatic recurrent malignant pleural effusions, particularly those with lung trapping or a limited life expectancy [ 2, 3 ].
- Palliation: TPCs provide a less invasive means to reduce dyspnea and improve quality of life in patients with malignant pleural effusions [ 1 ].
Clinical Guidelines
- The American College of Chest Physicians recommends the use of TPCs or chemical pleurodesis for patients with symptomatic recurrent malignant pleural effusions and documented re-expandable lung [ 2 ].
- The British Thoracic Society guidelines suggest that chronic indwelling pleural catheter drainage is an effective option for controlling recurrent and symptomatic malignant effusions in selected patients [ 4 ].
From the Research
Key Differences
- A tunneled pleural catheter (TPC) is a type of catheter that is inserted into the pleural space to drain fluid, typically used for long-term management of pleural effusions 5, 6.
- A thoracostomy tube, also known as a chest tube, is a tube that is inserted into the pleural space to drain fluid, air, or blood, and is often used for acute management of conditions such as pneumothorax, pleural effusions, and empyema 7, 8.
Indications and Usage
- TPCs are commonly used for outpatient drainage of malignant pleural effusions, and are also being increasingly used for non-malignant conditions such as congestive heart failure and hepatic hydrothorax 5, 6.
- Thoracostomy tubes are often used as a first-line treatment for various thoracic and pleural conditions, including pneumothorax, pleural effusions, and empyema 7, 8.
Design and Functionality
- TPCs are designed for long-term use and are typically inserted using a tunneling technique to reduce the risk of infection and other complications 5, 6.
- Thoracostomy tubes come in various designs, including small-bore and large-bore tubes, and may be used with suction or other drainage systems to enhance efficacy 7, 8.
Complications and Safety
- Both TPCs and thoracostomy tubes can be associated with complications such as infection, pneumothorax, and bleeding, although the risk of these complications can be minimized with proper insertion and management techniques 5, 8, 9.
- The use of small-bore catheters, such as those used for TPCs, may be associated with a lower risk of complications compared to large-bore thoracostomy tubes 9.