Chua Brian Lee Wei, Young Si Ling, Tan Qiao Li, Leong Carrie Kah-Lai, Wong Jane Jing Yi, Phua Ivana Gilcrist Chiew Sian, Lim Wen Ting, Goh Ken Junyang
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
Nursing Division, Singapore General Hospital, Singapore, Singapore.
J Thorac Dis. 2025 Mar 31;17(3):1512-1519. doi: 10.21037/jtd-24-1734. Epub 2025 Mar 17.
Indwelling pleural catheters (IPCs) are an established first-line treatment option for symptomatic malignant pleural effusions (MPEs). However, community nursing support for IPC care and drainage is not available in many healthcare systems. In this study, we sought to evaluate IPC outcomes and complication rates in patients for whom IPC care and home drainage are performed by family members and caregivers.
Patients who underwent IPC insertions between January 2017 to December 2022 were included in this observational cohort study. Caregiver training were provided to all patients and appointed caregivers by pleural specialist nurse. All patients were assessed at regular intervals every 1 to 2 months, until death or IPC removal. Clinical outcomes and adverse events were recorded prospectively.
We evaluated 140 patients with a median age of 68 years [interquartile range (IQR): 61-73 years]. MPE was the underlying etiology in 137 patients (97.9%). The most common causes of MPE were lung cancer (42.9%) and breast cancer (22.1%). The median duration of IPC placement was 64 (IQR: 36-120) days. About a third of patients (35.0%) had spontaneous pleurodesis allowing for removal of the IPC, with this occurring at a median of 78 (IQR: 52-144) days. The median length of survival from the time of IPC insertion was 102 (IQR: 41-308) days. IPC related complications occurred in 38 (27.1%) patients. Catheter malfunction, most commonly a non-draining IPC due to catheter blockage, occurred in 27 (19.3%) of patients, and 14 (10.0%) patients developed infective complications. Nine (6.4%) patients required hospitalisation for IPC-related complications. There were no bleeding complications or procedure-related deaths.
In healthcare systems without available community nursing services, IPCs remain a valuable treatment option for patients with symptomatic MPEs. Comparable clinical outcomes and safety profiles can be achieved even for patients where IPC care and drainage are primarily led by caregivers or family members, in the presence of appropriate support and caregiver training provided by a pleural service.
留置胸膜导管（IPCs）是有症状恶性胸腔积液（MPEs）既定的一线治疗选择。然而，许多医疗系统中没有社区护理对IPCs护理和引流的支持。在本研究中，我们试图评估由家庭成员和护理人员进行IPCs护理和家庭引流的患者的IPCs治疗效果和并发症发生率。
本观察性队列研究纳入了2017年1月至2022年12月期间接受IPCs置入的患者。胸膜专科护士为所有患者及其指定的护理人员提供了护理培训。所有患者每1至2个月定期评估一次，直至死亡或拔除IPCs。前瞻性记录临床结果和不良事件。
我们评估了140例患者，中位年龄为68岁[四分位间距（IQR）：61 - 73岁]。137例患者（97.9%）的潜在病因是MPE。MPE最常见的病因是肺癌（42.9%）和乳腺癌（22.1%）。IPCs置入的中位持续时间为64（IQR：36 - 120）天。约三分之一的患者（35.0%）出现自发性胸膜固定术，从而可以拔除IPCs，这发生在中位时间78（IQR：52 - 144）天。从IPCs置入时起的中位生存时间为102（IQR：41 - 308）天。38例（27.1%）患者发生了与IPCs相关的并发症。导管故障，最常见的是由于导管堵塞导致的IPCs不引流，发生在27例（19.3%）患者中，14例（10.0%）患者发生了感染性并发症。9例（6.4%）患者因IPCs相关并发症需要住院治疗。没有出血并发症或与操作相关的死亡。
在没有社区护理服务的医疗系统中，IPCs仍然是有症状MPE患者的一种有价值的治疗选择。即使对于主要由护理人员或家庭成员进行IPCs护理和引流的患者，在胸膜服务提供适当支持和护理人员培训的情况下，也可以实现可比的临床结果和安全性。
