Outpatient Pleurodesis Using Sclerosants(OPUS):Comparing Doxycycline Pleurodesis to Continued Drainage With the Pleurx Catheter System in the Treatment of Malignant Pleural Effusions in the Outpatient Setting
Patients with cancer may experience problems with their breathing due to a fluid
accumulation around their lungs called malignant pleural effusion (MPE). This fluid can be
drained but draining may not stop the fluid from accumulating again. MPE can cause
shortness of breath during activity and at rest leaving patients feeling as though they
cannot catch their breath enough to be comfortable. Other symptoms can include pain, cough
and weight loss.
One way to stop the fluid from accumulating is to create scar tissue between the lung and
chest wall so there is no more room for fluid accumulation. This procedure is called
pleurodesis. Pleurodesis is the standard of care at most centres across Canada. This
procedure is done by injecting a drug into the space between the lung and chest wall through
a catheter, Doxycycline is one of the drugs currently used for this purpose. Traditionally,
patients are admitted for pleurodesis, mostly because the size of the catheter used to
inject the medication is very large but also because of the potential complications that can
happen with these larger chest tubes.
At our centre, most patients with MPE are managed at home with a smaller sized catheter
known as a Pleurx catheter. The Pleurx catheter allows patients to remain at home for
treatment and trained staff come into the home to both drain the MPE and monitor the
patient. Sometimes, patients experience pleurodesis through use of the Pleurx catheter
Pleurodesis with doxycycline can happen faster than with the Pleurx catheter alone. It has
been our experience with a limited number of patients that it is safe to perform pleurodesis
using the Pleurx catheter for doxycycline injection in an outpatient setting.
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