Surgical drain repurposed as an indwelling pleural catheter

MS. Gopala Krishna*^a (Dr)

^a Aayush Hospital, Vijayawada, INDIA

* gopalkriss001@gmail.com

Aim

A proof of concept to demonstrate the closed wound surgical drain can be used as an alternative to indwelling pleural catheter for management of recurrent pleural effusions in resource constrained setting

Background

Despite the obvious advantages, the prohibitive cost of IPC’s and availability have limited their widespread adoption in developing countries. A closed wound surgical drain is economical and widely available and can be tunnelled subcutaneously like the IPC’s to achieve comparable outcomes.

Methods

IPC’s insertions are considered standard of care in management of recurrent pleural effusions. This is largely because they are reported in literature to reduce incidence of pleural infections and can be self-managed by the patient. Small bore (size 14 and16F) surgical drains were prospectively inserted in patients who presented with recurrent pleural effusions. The closed wound surgical drain was tunnelled subcutaneously like IPC’s and patients were taught to self-manage the same

Results

52 patients with recurrent pleural effusions of varying aetiologies were prospectively included into the study. 34 had Malignant Pleural Effusion, 14 with hepatic hydrothorax, 3 had chronic tubercular pleural effusions and one had Chylothorax. The mean duration of the catheter in situ was for 46 days (8 to 281 days). Auto-pleurodesis was achieved in 28 patients and the catheter was removed. Mild Pain was the most common complication reported in 41 patients . In 11 subjects the tube was clogged with debris however in only 2 patients this warranted reinsertion of new drain. Catheter site infection rate was 3.8% comparable to that seen in IPC’s.

Conclusion

The closed wound surgical drain is economical, effective and well tolerated and can be used in lieu of IPCs in resource constrained settings

Disclosure of funding source(s): none