Tunneled Pleural and Peritoneal Catheters

First, we review indications for tunneled catheters, the most common ones being malignancies. Since tunneled catheters are known to carry a risk of infection, their placement is often used as a palliative care measure. In addition to malignancies, they can also be used to improve symptoms in patients with congestive heart failure, cirrhosis, pancreatitis, autoimmune diseases, and chylothorax. Dr. Baheti emphasizes the importance of establishing chronicity and recurrence of the effusions before placing the tunneled catheter. For example, some patients with ascites could better benefit from a TIPS procedure rather than a peritoneal catheter.

Dr. Beck gives us advice for placing pleural tunneled catheters. He positions the patient to ensure the best access point, using a cloth roll underneath the ipsilateral hip and having the patient raise the ipsilateral arm. He also uses lidocaine injections for pain control and he makes a gentle curve to get a smooth angle of the catheter.
Dr. Baheti shares her own experiences with pleural tunneled catheter placement. She tunnels along the intercostal space and angles the needle into the posterior space to achieve a smooth angle. She also chooses the biggest fluid pocket to drain, where the fluid is at least 5 cm. She emphasizes that pre-procedural planning and the final location of the catheter tip has a large influence on whether or not the catheter can successfully drain fluid.

Throughout a patient’s care, clear communication with insurance, the patient, and the home caretakers are very important. Finally, Dr. Fritts says that the most important part about the procedure is counseling the pt. Realistically, it is hard for physicians to find time to explain the specific instructions of home care, so it is important to delegate at least one person on the medical team to do this.