Figure 1
Indwelling pleural catheter (cuff marked with red arrow) and a vacuum bottle on standby. Drainage clamp is marked with yellow arrow.
Source publication
The incidence of pleural disease is increasing, and pleural medicine is increasingly recognised as a subspecialty within respiratory medicine. This often requires additional training time. Once underresearched, the last decade has seen an explosion in evidence related to the management of pleural disease. One of the cornerstones of pleural effusion...
Contexts in source publication
Context 1
... incisions are made about 5 cm apart. A tract is created with straight forceps and the drain passed through, making sure that the cuff ( figure 1, red arrow) of the drain sits midway. A dilator and a sheath are passed over a guidewire through the proximal incision into the pleural cavity. ...
Context 2
... note, Rocket provide an adaptor for patients with PleurX drains, should they come to a centre where only Rocket supplies are available. Figure 1 depicts a Rocket IPC with a vacuum bottle on standby. Under aseptic conditions, the end of the drain is uncapped and the vacuum bottle attached. ...
Context 3
... pain during or following drainage is not uncommon (approximately 36% of patients), 11 15 and can be related to the position of the drain in the pleural space (eg, if close to and irritating the diaphragm or visceral surface) or the presence of non-expandable lung (the vacuum drainage process then creates significant negative intrapleural pressure which can be very painful for the patient). There are no randomised trials looking at this but we have found that controlling the rate of drainage (which can be slowed down using the button depicted by the red arrow in figure 1) ...
Context 4
... can be offered if pain or skin integrity becomes an issue. 20 21 IPC dislodgement IPC dislodgement is rare (less than 1% in some case series 22 ), as the cuff depicted in figure 1 is proinflammatory and allows epithelisation of the IPC after sutures are removed. However, the cuff can migrate distally so that continued use can contribute to dislodgement ( figure 7). ...
Citations
... Indwelling pleural catheters (IPCs) are increasingly utilized in the long-term management of pleural effusions (typically in the context of underlying malignancy) and offer a patientcentered approach to care that can be successfully delivered within the community setting [55]. Several randomized clinical trials (discussion of which is beyond the scope of this article) have been performed, generating a robust evidence base for the development of clinical guidelines that support their use in malignant pleural effusions [56]. ...
Hepatic hydrothorax (HH) represents a distinct clinical entity within the broader classification of pleural effusion that is associated with significant morbidity and mortality. The median survival of patients with cirrhosis who develop HH is 8-12 months. The diagnosis is typically made in the context of advanced liver disease and ascites, in the absence of underlying cardio-pulmonary pathology. A multi-disciplinary approach to management, involving respiratory physicians, hepatologists, and palliative care specialists is crucial to ensuring optimal patient-centered care. However, the majority of accepted therapeutic options are based on expert opinion rather than large, adequately powered randomized controlled trials. In this narrative review, we discuss the epidemiology, pathophysiology, clinical characteristics, and management of HH, highlighting the use of salt restriction and diuretic therapy, porto-systemic shunts, and liver transplantation. We include specific sections focusing on the role of pleural interventions and palliative care, respectively.
