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Efficacy and Safety of Intrapleural TPA Instillations in Patients with Loculated Pleural Effusions and Nonfunctioning or Infected Tunneled Catheters
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A4212 - Efficacy and Safety of Intrapleural TPA Instillations in Patients with Loculated Pleural Effusions and Nonfunctioning or Infected Tunneled Catheters
Author Block: G. Thommi1, J. Shehan1, B. Gale2, P. G. Meyers1; 1Pulmonary, Creighton University, Omaha, NE, United States, 2Methodist Hospital, Omaha, NE, United States.
Rationale: To document the efficacy and safety of TPA instillation in patients with tunneled catheters that are nonfunctioning and/or infected. Method: Patients with tunneled catheter placement for recurrent pleural effusions were evaluated for TPA instillation for nonfunctioning catheter, persistent loculated fluid collection, and/or infected catheter and pleural effusions. All patients had platelet function assay performed (PFA) and 10 mg TPA was instilled intrapleurally daily for 1-3 days. Patients were followed up for at least 6 months.
Results: 29 patients were entered into the study with nonfunctional tunneled catheters with persistent or worsening loculated effusions of which 4 patients' catheters and effusions were infected. A total of 41 treatments sessions were performed. 5 patients had to have more than one treatment session. Twenty two patients had malignant/suspected malignant effusions of which 2 were parapneumonic effusions and 2 were empyemas. All other effusions were related to CHF or renal disease. 39/41 treatments sessions were successful with significant resolution of the pleural effusions and empyema. Two patients responded to TPA but these effusions recurred shortly as the lung was trapped. The two patients with mild to moderate loculated effusion that did not respond to TPA had their catheters removed as pleurodesis was presumed to have occurred. Twenty four patients had their catheters removed within 3 months of TPA instillation, one patient was lost to follow up and six patients were transferred to hospice. Conclusion: Nonfunctioning/infected tunneled catheters respond well to TPA instillation and no significant complications were noted. Intrapleural TPA instillations prevents thoracentesis, catheter replacements and/or other surgical procedures. TPA instillations appear to facilitate pleurodesis as over 70% of patients treated had their catheters discontinued.
Author Block: G. Thommi1, J. Shehan1, B. Gale2, P. G. Meyers1; 1Pulmonary, Creighton University, Omaha, NE, United States, 2Methodist Hospital, Omaha, NE, United States.
Rationale: To document the efficacy and safety of TPA instillation in patients with tunneled catheters that are nonfunctioning and/or infected. Method: Patients with tunneled catheter placement for recurrent pleural effusions were evaluated for TPA instillation for nonfunctioning catheter, persistent loculated fluid collection, and/or infected catheter and pleural effusions. All patients had platelet function assay performed (PFA) and 10 mg TPA was instilled intrapleurally daily for 1-3 days. Patients were followed up for at least 6 months.
Results: 29 patients were entered into the study with nonfunctional tunneled catheters with persistent or worsening loculated effusions of which 4 patients' catheters and effusions were infected. A total of 41 treatments sessions were performed. 5 patients had to have more than one treatment session. Twenty two patients had malignant/suspected malignant effusions of which 2 were parapneumonic effusions and 2 were empyemas. All other effusions were related to CHF or renal disease. 39/41 treatments sessions were successful with significant resolution of the pleural effusions and empyema. Two patients responded to TPA but these effusions recurred shortly as the lung was trapped. The two patients with mild to moderate loculated effusion that did not respond to TPA had their catheters removed as pleurodesis was presumed to have occurred. Twenty four patients had their catheters removed within 3 months of TPA instillation, one patient was lost to follow up and six patients were transferred to hospice. Conclusion: Nonfunctioning/infected tunneled catheters respond well to TPA instillation and no significant complications were noted. Intrapleural TPA instillations prevents thoracentesis, catheter replacements and/or other surgical procedures. TPA instillations appear to facilitate pleurodesis as over 70% of patients treated had their catheters discontinued.
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