Pleural Catheter

The pleura is a thin membrane around your chest cavity that surrounds your lungs. In between the layers of the pleura, there is a small space called the pleural cavity which contains a small amount of fluid. This helps the lungs to move seamlessly while breathing. When excess fluid accumulates in the cavity, it results in a condition called pleural effusion, which makes it difficult to breath and may cause severe chest pain.

Conventionally, pleural fluid drainage is performed with a chest tube insertion. However, this method is uncomfortable and requires repeated hospital admission whenever fluid accumulates. A pleural catheter is a specially designed thin tube that is inserted into the pleural cavity and left in the body to remove fluid whenever necessary. With the catheter in place, you will not have to insert a chest tube each time excess fluid collects in the pleura. One end of the catheter remains in the chest cavity and the other end passes out through the skin. The tube is flexible and soft and is connected with a one-way valve on either end to prevent air leaking inside the tube and fluid leaking out of the tube.

Indications

A pleural catheter may be indicated for conditions like pleural effusion, ascites (fluid in the abdomen), lung cancer, liver disease and congestive heart failure.

Procedure

The insertion of the pleural catheter is generally performed as an outpatient procedure. Your doctor may ask you to lie in a comfortable position. Local anaesthesia is given to prevent pain at the site of insertion of the catheter. Your doctor inserts a needle into the pleural cavity and inserts a guide wire through the needle. The needle is then carefully removed, leaving behind the guide wire. Two small incisions are made, one to make a tunnel for the catheter (at the guide wire insertion site) and the other just below the first incision. Your doctor inserts the catheter into the lower incision and advances it until the end of the catheter is through the other incision. Your doctor uses ultrasound guidance to guide the catheter into the pleural cavity over the guide wire, and the guide wire is carefully removed. The excess pleural fluid is drained out into a bottle, and the incisions are firmly sutured. The outer end of the catheter is then connected to a vacuum bottle to drain out the excess pleural fluid.

One end of the catheter remains outside the body, under a bandage. When the pleural fluid accumulates, you can connect the end of the catheter to the vacuum bottle, and the bottle will automatically draw out the fluid.

Post-procedure Care

You may have to stay in the recovery room for 2 hours after the procedure. Your physician will instruct you and your caregiver on how to operate the catheter. You will be advised to drain the fluid every one or two days. You should not drain the fluid for more than 1,000 to 1,500 millilitres in a day. The catheter may be removed once the fluid build-up stops.

Risks and Complications

Insertion of a pleural catheter is mostly a safe procedure that is routinely used, but like all procedures, it may be associated with certain complications. Some of the risks associated with pleural catheter insertion include:

• Infection in the pleural space
• Hypotension (low blood pressure)
• Protein depletion
• Electrolyte imbalance
• Circulatory system failure
• Ascites leakage

Advantages

Pleural catheter insertion is a minimally invasive method for draining extra pleural fluid. Pleural fluid removal can be performed whenever necessary, even at home with a pleural catheter in place.