Clinical outcomes of caregiver-led indwelling pleural catheter care and drainage at a Singapore tertiary referral hospital.

Abstract

Background: Indwelling pleural catheters (IPCs) are an established first-line treatment option for symptomatic malignant pleural effusions (MPEs). However, community nursing support for IPC care and drainage is not available in many healthcare systems. In this study, we sought to evaluate IPC outcomes and complication rates in patients for whom IPC care and home drainage are performed by family members and caregivers.

Methods: Patients who underwent IPC insertions between January 2017 to December 2022 were included in this observational cohort study. Caregiver training were provided to all patients and appointed caregivers by pleural specialist nurse. All patients were assessed at regular intervals every 1 to 2 months, until death or IPC removal. Clinical outcomes and adverse events were recorded prospectively.

Results: We evaluated 140 patients with a median age of 68 years [interquartile range (IQR): 61-73 years]. MPE was the underlying etiology in 137 patients (97.9%). The most common causes of MPE were lung cancer (42.9%) and breast cancer (22.1%). The median duration of IPC placement was 64 (IQR: 36-120) days. About a third of patients (35.0%) had spontaneous pleurodesis allowing for removal of the IPC, with this occurring at a median of 78 (IQR: 52-144) days. The median length of survival from the time of IPC insertion was 102 (IQR: 41-308) days. IPC related complications occurred in 38 (27.1%) patients. Catheter malfunction, most commonly a non-draining IPC due to catheter blockage, occurred in 27 (19.3%) of patients, and 14 (10.0%) patients developed infective complications. Nine (6.4%) patients required hospitalisation for IPC-related complications. There were no bleeding complications or procedure-related deaths.

Conclusions: In healthcare systems without available community nursing services, IPCs remain a valuable treatment option for patients with symptomatic MPEs. Comparable clinical outcomes and safety profiles can be achieved even for patients where IPC care and drainage are primarily led by caregivers or family members, in the presence of appropriate support and caregiver training provided by a pleural service.