PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

Abstract

Objectives: The aim of this article was to assess the success, safety, complication profile and factors associated with long-term patency of tunnelled peritoneal drains (PleurX) in the treatment of refractory malignant ascites.

Methods: Over a 4-year period, 28 consecutive patients (32 drain insertions) with refractory malignant ascites were treated with a PleurX drain. The study group comprised 7 males and 21 females (mean age, 61 years). A combination of fluoroscopic and ultrasound guidance was used to insert 4 drains; the remaining 28 drains were inserted under ultrasound guidance alone. Patient history, biochemical profiles, pathological and procedural records and clinical follow-up until death were reviewed. Statistical analysis included multivariate logistic regression analysis and Kaplan-Meier curves (p<0.05 was considered significant).

Results: There was a 100% technical success rate for the insertion of the drain; there were no procedure-related deaths and no major complications. Only minor complications were reported: three (10%) immediate; three (10%) early; and two (7%) late. Factors significantly associated with these complications included current chemotherapy, low haemoglobin levels, low albumin levels, high white cell count and high c-reactive protein levels. The length of time the drains remained in situ, and therefore patent, ranged from 5 to 365 days (mean, 113 days). Out of the original 28 tunnelled drains, 24 (86%) remained in situ and functioning until the patients' death. Four (14%) drains dislodged and a subsequent PleurX drain was inserted on the opposite side of the abdominal wall. These new drains remained patent until the patient's death. The annual event rate was 0.45 events per year. A comorbid diagnosis of renal disease or chemotherapy was significantly related to a decreased length of patency.

Conclusion: The use of tunnelled peritoneal drains is safe and effective and we would advocate their use as a first-line approach in patients with refractory malignant ascites. Care and regular follow-up is indicated following insertion of the drain in all patients, especially those on chemotherapy and those with a pre-procedure diagnosis of renal disease.

Figures

Figure 1

(a) Dimensions and location of various components of the PleurX peritoneal catheter (UK Medical, Sheffield, UK), (b) Dimensions of the drainage line. (Figure reproduced courtesy of CareFusion Corporation or one of its subsidiaries, 2010. All rights reserved.)

Figure 2

Ideal location of the tunnelled drain indicating the site of the incisions and the location of the cuff. (Figure reproduced courtesy of CareFusion Corporation or one of its subsidiaries, 2010. All rights reserved.)

Figure 3

Simple mechanism for attaching the end of the tunnelled drain into one of the 500 ml drainage bottles. (Figure reproduced courtesy of CareFusion Corporation or one of its subsidiaries, 2010. All rights reserved.)

Figure 4

Kaplan–Meier patient survival curves showing (a) the interval between drain placement and drain failure or patient death, (b) comorbid factors (Log rank p=0.041) and the interval between drain placement and drain failure or patient death and (c) chemotherapy status (Log rank p=0.022) and the interval between drain placement and drain failure or patient death. DM, diabetes mellitus; HT, hypertension; IHD, ischaemic heart disease.