What are the common side effects of an indwelling pleural catheter (IPC)?

Common Side Effects of Indwelling Pleural Catheters

The most common side effect of indwelling pleural catheters is local cellulitis and catheter-related infections, occurring in approximately 5% of patients, followed by catheter blockage (occurring in up to 11% of cases) and catheter displacement. 1

Infectious Complications

Infection is the most frequently reported complication, with an overall incidence of approximately 4.9-8% across large series. 1, 2

• Local cellulitis is the single most common infectious complication, representing the majority of infection cases. 1
• Pleural space infection/empyema occurs in approximately 2.8-3% of patients. 1, 3, 2
• Staphylococcus aureus is the causative organism in 48% of IPC-related infections, making it the most common pathogen. 2
• Gram-negative infections carry worse outcomes, with 60% requiring continuous antibiotics or resulting in death compared to 15% with gram-positive infections. 2
• The overall mortality risk directly attributable to IPC-related pleural infection is only 0.29%, as most infections (94%) are successfully controlled with antibiotics without catheter removal. 2

Mechanical Complications

Catheter blockage is the second most common complication after infection:

• Occurs in approximately 2-11% of patients depending on the series. 1
• Usually managed without catheter removal through fibrinolytic therapy. 4, 5

Catheter displacement occurs in 2-4% of cases:

• Requires repositioning or replacement. 1
• More common in the first few weeks after insertion. 1

Peri-catheter fluid leakage affects approximately 2-13% of patients:

• More common with high-volume effusions. 1
• Usually resolves with drainage frequency adjustment. 4

Less Common but Serious Complications

Tumor seeding along the catheter tract is rare but notable:

• Occurs in approximately 0.8-1% of cases overall. 1, 3
• More common in mesothelioma patients, where prophylactic radiotherapy should be considered. 5

Pneumothorax requiring chest tube occurs in approximately 5.9% of cases. 3

Skin reactions to dressing materials are uncommon, affecting approximately 1% of patients. 1

Critical Clinical Caveats

The overall complication rate is approximately 14%, which is considered acceptable given the palliative nature of treatment and the significant reduction in hospitalization (1 day versus 6 days for pleurodesis). 1, 3

Most complications do not require catheter removal: 54-62% of infections are managed successfully with antibiotics alone, and the catheter can remain in place. 6, 2

Post-infection pleurodesis occurs in 62% of patients who develop IPC-related infections, particularly with staphylococcal infections (79%), often allowing eventual catheter removal. 2

The risk of infection increases with duration of catheter placement, but quality improvement measures including preoperative antibiotics, full sterile draping, and standardized placement techniques can reduce infection rates from 8.2% to 2.2%. 7