The Evolution of the Indwelling Pleural Catheter

Abstract

An indwelling pleural catheter (IPC) is a valuable tool in the management of pleural effusions, allowing drainage strategies to be tailored to match patient-centred goals. Previously, IPCs were primarily utilised in malignant pleural effusion (MPE) in the presence of non-expandable lung (NEL) or after the failure of chemical pleurodesis. Several studies have compared IPC to intercostal chest drain (ICD) with talc pleurodesis (TP), as well as different drainage regimens, resulting in a transition of practice. Continued developments have led to novel adjuncts, such as digital drainage, which allow controlled flow rates. The emerging field of intrapleural therapy in MPE is gaining attention as a potential new treatment modality, possibly increasing the scope of IPCs further. This article will provide a narrative review of the role of IPCs and will be based on published evidence to date and highlight the importance of an individualised, patient-centred care approach.

Keywords: Benign pleural effusion; IPC; Indwelling pleural catheter; Malignant pleural effusion; Pleural effusion.

Fig. 1

An IPC (image reproduced with permission from Rocket Medical plc). IPC indwelling pleural catheters

Fig. 2

Summary of the utility of IPCs. Images of IPC reproduced with permission from Rocket Medical plc. Images of Passio™ reproduced with permission from Bearpac Medical (Moultonborough, NH, USA). IPC indwelling pleural catheters

Fig. 3

Timeline of IPC trials. TP talc pleurodesis, ICD intercostal chest drain, TTP thoracoscopy with talc poudrage, SN silver nitrate, TT therapeutic thoracentesis, IPC indwelling pleural catheters

Fig. 4

Algorithm for IPC usage using current evidence. *e.g., renal failure, chylothorax, inflammatory pleuritis. MPE malignant pleural effusion, BPE benign pleural effusion, ICD intercostal chest drain, TP talc pleurodesis, AP antiplatelet, AC anticoagulation, IPC indwelling pleural catheters