Early experience with outpatient tube drainage for management of pleural collections.

Abstract

BACKGROUND: Increasing cases of pleural effusion leads to pressure on bed spaces and a stretch of the limited facilities available for intervention in our centre. This therefore prompted a search for acceptable alternative way of treatment. OBJECTIVE: To evaluate the use of ambulatory drainage system for chronic infectious and malignant pleural effusion on outpatient basis. METHODS: Eight of 113 routinely performed closed tube thoracostomies drainage were converted to ambulatory drainage system at the time of patients discharge to follow-up clinic. This was after the catheter care had been thoroughly explained to the patients and their relatives. RESULTS: Eight patients (seven males and one female) had ambulatory outpatient tube management. Their mean age was 44.9 (18) years with a range of 22 to 70 years. Histologically confirmed causes of the effusion were; metastatic adenocarcinoma in two(25%) of the cases; chronic nonspecific inflammation in another two(25%) and tuberculous empyema thoracis in three(37.5%) one of whom had TB and HIV coinfection and one(12.5%) of chronic bacterial parapneumonic empyema. One case each of metastatic adenocarcinoma and chronic non-specific suppuration had failed chemical pleurodesis before the outpatient drainage procedure. Half of the cases (including tuberculous and non-tuberculous) were successfully weaned off their catheters. Minor complications such as pain, discomfort, minimal stoma bleeding, and peri-catheter leak were recorded. Rapid fluid re-accumulation prevented weaning in two (25%) of the cases. CONCLUSION: Out-patient chest tube drainage is effective for the management of both malignant and suppurative pleural effusion. This approach would reduce the ever increasing cost of hospital care for this group of patients.