Chest PleurX catheter

Your lungs sit inside a thin, two-layer lining called the pleura. Normally there is only a spoonful of fluid between the layers. When too much fluid collects there, it is called a pleural effusion. The fluid squeezes the lung, which can make you short of breath, cough or feel heavy on one side of the chest.

Draining the fluid with a needle, called thoracentesis, usually brings quick relief. But in some conditions the fluid comes back within days or weeks. The most common cause is cancer that spreads to the pleura, often from the lung, breast or ovary, or lymphoma. Heart failure, liver disease and kidney disease can also cause fluid that keeps returning.

A tunneled pleural catheter, often called by the brand name PleurX, is a soft tube that stays in place for weeks to months. You drain the fluid at home instead of coming back for another needle.

On ultrasound, pleural fluid looks like a black space above the diaphragm, with the lung floating in it. After placement, a chest X-ray shows the thin white catheter curving along the base of the lung.

Large studies comparing a tunneled catheter with talc pleurodesis found that both relieve breathlessness about equally. The catheter usually means fewer days in the hospital. Pleurodesis means no tube to care for afterward. Treating the cause, for example with chemotherapy, can also slow the fluid. Your lung doctor, cancer doctor and we will help you decide. See pleurodesis.

The procedure is done at El Camino Hospital in the interventional radiology suite. A nurse, a technologist and your interventional radiologist care for you. Your heart rate, blood pressure and oxygen are watched the whole time.

1. 1
   Getting comfortable

   You lie on your back or side. Medicine through your IV, called moderate or twilight sedation, helps you relax. You stay awake but drowsy.

2. 2
   Numbing and planning

   We use ultrasound to find the fluid and mark a safe spot between the ribs. The skin is cleaned and numbed. You may feel a sting and some pressure.

3. 3
   Placing the catheter

   A thin needle enters the fluid, and a guidewire goes through it. We make a second small opening a few inches away and pass the tube under the skin to form a short tunnel. The tube then slides over the wire into the pleural space.

4. 4
   First drainage

   The tube is connected to a vacuum bottle and some fluid is drained, usually up to about 1 liter. We stop sooner if you feel chest tightness or start coughing hard.

5. 5
   Closing up

   The opening where the tube entered the chest is closed with a stitch or glue. The tube is secured and covered with a dressing.

You recover for 30 to 60 minutes. You can eat, drink and see your family. A chest X-ray may be done to check the tube. Before you leave, a nurse shows you and a family member how to drain, and you go home with a starter kit. More supplies are shipped to your home.

1. Day of procedure
   Rest. No driving, alcohol or important decisions if you had sedation. Mild soreness is normal; acetaminophen or ibuprofen usually helps.
2. Next day
   Back to light activity. You may shower if the site is covered with a waterproof dressing.
3. First week
   No heavy lifting or strenuous activity. Drain as we instruct, often every day or every other day at first.
4. 7 to 10 days
   The stitches at the skin are usually removed in clinic or by a home nurse.
5. After 2 weeks
   The tunnel has healed around the cuff. The site can get wet in the shower; pat dry and put on a new dressing.

I think of the chest catheter as giving control back to my patients. Instead of waiting until they are gasping for breath and then coming to the hospital, they drain a little before it gets bad. On the ultrasound, I look for how much the lung moves and whether there are thin strands in the fluid, because both affect how well the catheter will drain and how likely the lung is to seal.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Most people breathe more easily after the first drainage. Over time, in roughly 1 in 4 to 1 in 2 people, the two layers of pleura stick together on their own and the fluid stops. This is called spontaneous pleurodesis. It is more likely when you drain often and your lung fully re-expands.

When you get little or no fluid on three drainages in a row, we check with an X-ray or ultrasound. If the fluid is gone, the catheter can be removed in clinic with numbing medicine in about 15 minutes. If the catheter is still helping, it can safely stay for months.