Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients.
Intern Med J. 2019 Sep 30;:
Authors: Chan KP, Badiei A, Tan CP, Fitzgerald DB, Stanley C, Fysh ETH, Shrestha R, Muruganandan S, Read CA, Thomas R, Lee YG
INTRODUCTION: Patients suffering from malignant ascites usually require repeated large volume paracentesis (LVP) for symptomatic relief. This often requires hospital admission and has inherent risks.
AIM: To report the first Australian experience of placing tunneled indwelling peritoneal catheters (IPeC) for management of recurrent malignant ascites.
METHODS: A retrospective study was conducted of tunneled IPeC use in patients with symptomatic malignant ascites in four hospitals in Western Australia (from 2010-2018). Procedure data, success rate and safety profile were collected from a database.
RESULTS: Forty-eight patients (median age, 65 years; female 56%) underwent 51 peritoneal catheter insertion procedures that were performed mostly by pleural specialists. The majority of patients (96%) had prior LVP (median 2 drainages, interquartile range (IQR) 1-4) before IPeC insertion. The IPeC was inserted successfully under ultrasound guidance in all patients. The median length of hospital stay for IPeC insertion and initial ascites drainage was 2 days (IQR 2-3 days) and most patients (96%) did not require further paracentesis after IPeC placement. The majority (96%) of patients experienced relief from ascites symptoms after catheter insertion. Most IPeC-related adverse events were self-limiting, including pain (in 25% cases), transient hypotension after initial fluid drainage (10%), peritoneal fluid leakage (10%), bacterial peritonitis (8%), fluid loculation (2%) and catheter dislodgement (2%). Six (12%) patients had IPeC removed. All patients with bacterial peritonitis responded to antibiotics and one required catheter removal.
CONCLUSIONS: Use of tunneled IPeC improves symptoms and can minimise further invasive drainage procedures in patients with symptomatic malignant ascites. Placement of IPeC was associated with a low rate of adverse events, most of which could be managed conservatively. This article is protected by copyright. All rights reserved.
PMID: 31566871 [PubMed - as supplied by publisher]