Outpatient Removal of PleurX Catheter
PleurX catheters can be safely removed in the outpatient setting when drainage decreases to less than 50 mL per day, typically indicating successful spontaneous pleurodesis. 1
Indications for Catheter Removal
The primary criterion for PleurX catheter removal is:
- Drainage volume less than 50 mL/day - This threshold indicates adequate fluid control and potential spontaneous pleurodesis 1
- Completion of the original indication - When the clinical purpose for the catheter has been fulfilled 2
- Catheter not used for 48 hours or longer - In stable patients without ongoing need 2
Approximately 58% of PleurX catheters can be successfully removed after drainage tapers off, with only a 3.8% reaccumulation rate following removal 1. This high success rate supports outpatient removal as standard practice.
When Catheter Removal Should Be Delayed or Reconsidered
Patients with trapped/nonexpandable lung have significantly prolonged drainage times (>100 days) and lower likelihood of successful catheter removal 1. In these cases:
- The catheter may need to remain in place indefinitely for palliation 1
- Removal should only be attempted if drainage criteria are met despite the trapped lung 1
Mandatory Indications for Catheter Removal (Regardless of Setting)
The catheter must be removed in the following circumstances, per ATS/STS/STR guidelines:
- IPC-associated infection that fails to improve despite appropriate antibiotic therapy 2
- Catheter malfunction or blockage that cannot be resolved (occurs in approximately 4.8% of cases) 1
However, for uncomplicated IPC-associated infections, treating through the infection without catheter removal is usually adequate 2. Only remove if infection persists despite antibiotics 2.
Outpatient Removal Procedure Considerations
Physician notification is required before catheter removal 2. The removal should be performed by:
- Clinicians specifically trained in PleurX/tunneled catheter removal 2
- Not by personnel only trained in standard CVC removal 2
The actual removal procedure is straightforward and can be safely performed in the outpatient setting with minimal complications 1, 3.
Post-Removal Monitoring
Following catheter removal:
- Reaccumulation risk is low (3.8%) in appropriately selected patients 1
- Monitor for recurrent symptoms over the subsequent weeks 1
- If reaccumulation occurs, repeat thoracentesis or catheter reinsertion may be necessary 1
Common Pitfalls to Avoid
- Do not remove the catheter prematurely (before drainage decreases to <50 mL/day) as this increases reaccumulation risk 1
- Do not routinely remove catheters for uncomplicated infections - treat with antibiotics first 2
- Do not assume all patients will achieve pleurodesis - only 16-58% achieve spontaneous pleurodesis allowing removal 1, 4
- Ensure proper training - removal by untrained personnel is inappropriate 2