Clinical Evaluation of Patients who Underwent Pleurocan Drainage Due To Pleural Effusion IN The Emergency Department: Review of 54 Cases

Abstract

61 Koyuncu et al., Pleuracan Drainage due to Pleural Effusion in the Emergency Department / doi: 10.14744/hnhj.2019.30306 200.000 people annually in the US, and they are the most common causes of exudative pleural effusions following infections [5–8]. Pleural effusion is a frequently encountered condition in emergency services. Respiratory distress, chest pain, and dry cough are the most common symptoms. These patients are usually tachypneic, tachycardic, and dyspneic. Respiratory sounds are reduced in the area of effusion, and dullness is detected in the percussion area [9–12]. The first step in the diagnosis of pleural effusion is posteroanterior chest radiography. For the diagnostic approach, computed tomography is the first imaging diagnostic tool to be resorted to. Ultrasonography is important in the diagnosis of loculated fluids [9–12]. Effusions impairing respiratory function require immediate intervention. For this purpose, thoracentesis, tube thoracostomy, and other thoracic catheters are applied. Thoracentesis is a procedure that provides fluid and air drainage from the pleural space with a needle, and it can be applied for diagnosis and treatment. Tube thoracostomy is the process of placing drain in the pleural space [12, 13]. Large-diameter thoracic catheters and small-diameter thoracic catheters (SDTCs) can be used to drain the pleural space. In the literature, catheters smaller than 20F are usually referred to as SCTC . SDTCs generally cited in the literature include Pigtail (7-8.5F, Cook Critical Care; Cook Incorporated; Bloomington, IN), Plöroken (8-10F, B. Braun, Melsungen, Germany), and Pleurx (15.5F, Care-Fusion, San Diego, CA, USA). They are marketed in different brands and diameters [14]. The Pleuracan catheter (Pleuracan, B. Braun, Melsungen, Germany) is a radiopaque catheter made of polyurethane with diameters of 8–10F and measuring 2.7×450 mm. It is usually used for the drainage of benign pleural fluids or fluids in loculations. There is a protective sheath around the catheter. The outer cannula is 3.35–78 mm in diameter. It is made of two-way stopcock, double-valve spacer, drain bag, and 60mm injector parts. The tip is located in a sharp tubular guide apparatus (cannula). Thanks to the outer pouch sheath that encloses the entire catheter, the introduction of air from outside of the chest cavity during the procedure, and thus development of iatrogenic pneumothorax, is prevented. The most frequent complication of thoracostomy is pneumothorax (5%). Other complications may include pulmonary contusion, liver rupture, splenic rupture, hemothorax, local hematoma, intraabdominal hemorrhage, and air embolism [12, 15, 16]. When thoracentesis is performed, no more than 1000–1500 ml of fluid should be discharged at a time. If large amounts of fluid are evacuated within a short time, pulmonary edema and severe hypotension develop in some patients [15]. The first thing to do after taking the pleural effusion sample is differentiation between transudate and exudate. Effusions with transudative characteristics are caused by oncotic and hydrostatic pressure changes in the pleura. Endothelial and pleural integrity was preserved. If these pressure changes are corrected, the pleural fluid spontaneously disappears. The most common causes of transudative pleural effusions are congestive heart failure, cirrhosis, and pulmonary embolism. Exudative pleural effusions develop due to the change of local factors in the pleura. The most common causes of exudates are pneumonia, cancer, and pulmonary embolism. In this study, we evaluated the age, sex, and demographic characteristics of the patients with massive pleural effusion in whom pleural fluid was evacuated for the treatment by using Pleuracan in the emergency medicine clinic in our hospital. This study aimed to perform a case series analysis and review the compliance of the data with those of the literature. Materials and Methods This study was carried out between January 1 and December 31, 2016, to determine the patients who were diagnosed in SBUHNEAH Emergency Medicine Clinic as having massive pleural effusions that were decided to be evacuated with the intention of treatment using a small-caliber 8–10F thoracic catheter Pleuracan (B. Braun, Melsungen, Germany) The records of these patients were obtained from the ICD 10 diagnostic coding system. During this period, Pleuracan catheter was inserted in 255 patients in the hospital, and 54 of them were implanted in the emergency medicine department. Data related to age, sex, demographic characteristics, pleural effusion, underlying cause of the pleural effusion, the characteristics of the pleural fluid, and development of complications (if any) during the procedure were collected from the patient file, and recorded in the pre-prepared data collection form.