What are the guidelines for caring for a Pleurx (percutaneous drainage catheter) drain?

PleurX Drain Care Guidelines

PleurX catheters should be managed by appropriately trained healthcare personnel with proper equipment to minimize complications and ensure optimal patient outcomes. 1

General Management Principles

• All PleurX chest tubes should be connected to a unidirectional flow drainage system that must be kept below the level of the patient's chest at all times 1
• Patients with PleurX drains should be managed on specialized wards by staff trained in chest drain management 1
• All patients discharged with a PleurX catheter should be referred to community nursing teams for early assessment of the wound site, symptom control, and support with drainage 1

Drainage Protocol

• For indwelling pleural catheters (IPCs) where removal is a priority, daily drainage is recommended to increase pleurodesis rates 1
• For symptom management only, less frequent drainage (symptom-guided or alternate day) can effectively control breathlessness and chest pain 1
• Patients and caregivers should be supported to perform community drainage and maintain a drainage diary to promote independence 1, 2

Complication Prevention and Management

• When there is sudden cessation of fluid draining, the drain must be checked for obstruction (blockage or kinking) by flushing 1
• A bubbling chest drain should never be clamped 1
• If a clamped drain causes breathlessness or chest pain, it should be immediately unclamped and medical advice sought 1
• Complications requiring referral back to the pleural team include:
  • Infection refractory to community management
  • Suspected drain fracture
  • Loculations or blockage with persistent breathlessness 1, 2

Infection Prevention

• The risk of infection with long-term PleurX catheters is approximately 2-5% and typically presents as insertion site cellulitis 2, 3
• Proper aseptic technique during drainage procedures is essential to minimize infection risk 4, 5
• Prolonged use (beyond several months) may increase empyema risk, particularly in non-malignant conditions 6, 3

Catheter Removal

• The drain should be removed once there is clinical resolution of the effusion 1
• For malignant effusions, removal can be considered when drainage is less than 50 mL/day for several days 2, 3
• Approximately 58% of catheters placed for malignant effusions can eventually be removed due to spontaneous pleurodesis 2

Special Considerations

• The psychological implications and altered body image from having a semi-permanent drain should be considered prior to insertion 1
• For malignant pleural effusions with septations, intrapleural fibrinolytics may be considered to improve drainage and symptom control 1
• In cases where pleurodesis is desired, talc instillation via the PleurX catheter can be offered to patients with expandable lung 1

Patient and Caregiver Education

• Proper case selection and caregiver training are essential for successful outpatient management 4, 5
• Education should include:
  • Aseptic drainage technique
  • Recognition of complications
  • When to seek medical attention
  • Proper disposal of drainage materials 4, 3