Percutaneous small-bore catheter


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Percutaneous small-bore catheter - 1

Available online at EJSO xx (2011) 1e6 Preliminary results of a new small-bore percutaneous pleural catheter used for treatment of malignant pleural effusions in ECOG PS 3e4 patients P.L. Filosso*, A. Sandri, G. Felletti, E. Rufni, P.O. Lausi, A. Oliaro University of Torino, Department of Thoracic Surgery, San Giovanni Battista Hospital, Via Genova, 3 10126 Torino, Italy Accepted 15 September 2011 Abstract Background: In cancer patients with malignant pleural effusions(MPEs),the commonest procedure to treat them with palliative intention is talc pleurodesis (TP) which can be obtained with talc slurry (TS) using small-bore catheters(SBC)or with thoracoscopic poudrage. SBC use is therefore rapidly increasing. The aim of this paper is to present our preliminary TP results using a new percutaneous chest drainage system(UNICOÒ,Redax,Mirandola Modena, Italy). Methods: In the period 1st Marche20th of July 2011,seven consecutive ECOG PS 3e4 patients(4 females, mean age 73.2 Æ 12.1 years),unt for thoracoscopic talc poudrage, were enrolled in our study. All patients received many thoracentesis before the placement of a chest drainage(median thoracentesis number:4.42 Æ 1.13).UNICOÒ was bedside placed in all cases and TS was administered through the drainage when the overall uid amount didn’t exceed 150e200 ml/24 h and the lung was correctly re-expanded at the chest X-ray control. Results: There were no clinical complications following the placement of the drainage: its placement was easy, safe and well-tolerated by all patients. The median chest tube stay, before TS, was 7.2 Æ 2.7 days while the median chest tube stay after TS was 1.5 Æ 0.7 days. A satisfactory radiological lung expansion was achieved in all cases; PL effectiveness and dyspnea relief were complete in 6 and 4 cases, respectively. No patients required any further thoracentesis. Conclusions: TS through UNICOÒ is safe and efcient. The drainage was well-tolerated by all patients, even in case of its long-term stay. We may conclude that bedside TS through this new small-bore percutaneous drainage should be proposed as a viable clinical solution for MPEs in ECOG PS 3e4 patients, unt for a thoracoscopic procedure. Moreover, with this device, we believe that TS might be an accessible procedure for pulmonologists and oncologists too. Ó 2011 Elsevier Ltd. All rights reserved. Keywords: Cancer; Malignant pleural effusions; Small-bore catheter; Drainage; Pleurodesis Introduction Malignant pleural effusions (MPEs) are a very common clinical problem in cancer patients: in fact they can occur as a primary cancer clinical presentation, as a delayed complication in patients with a previous history of cancer or as a clinical manifestation of cancer recurrence after therapy. MPEs may result from a primary tumor of the pleura (e.g.: malignant mesothelioma) or from other cancers reaching the pleural space by hematological, lymphatic or contiguous spread. MPEs are secondary to a primary lung cancer in more than one third of cases; breast cancer, lymphomas * Corresponding author. Fax: þ39 011 6705365. E-mail address: (P.L. Filosso). (Hodgkin’s and non-Hodgkin’s) and gastric cancers are other common causes of MPEs. Less commonly they are derived by ovarian, colon or prostate tumors. The annual incidence of MPE in US is estimated to be higher than 150,000 cases per year,1e3 even if there are no denitive inherent epidemiologic studies proving this data. As members of a cancer multidisciplinary care team, thoracic surgeons are very often requested to treat patients with MPEs in their daily clinical practice. Pleurodesis (PL) as MPEs management with palliative intent, represents the commonest treatment. PL results in the elimination of the pleural space, thus preventing uid reaccumulation and it may be accomplished with both chemical or mechanical irritation of the 0748-7983/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2011.09.037 Please cite this article in press as: Filosso PL, et al., Preliminary results of a new small-bore percutaneous pleural catheter used for treatment of malignant pleural effusions in ECOG PS 3e4 patients, Eur J Surg Oncol (2011), doi:10.1016/j.ejso.2011.09.037

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Percutaneous small-bore catheter - 2

pleura. PL may be achieved through a thoracoscopic proce- dure or via a chest tube placement, both of which are now- adays standard methods of care. Usually, thoracoscopic TP is considered to be the gold standard of care for fit patients, while talc slurry (TS) through the chest tube is reserved to those patients with im- portant comorbidities and in those ones who do not tolerate Finally, tunneled pleural catheters are offered to patients with an end-stage disease in which symptoms palliation is The most appropriate size of the chest tube for a pleural effusion drainage and TP is still a...

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Percutaneous small-bore catheter - 3

P.L. Filosso et al. / EJSO xx (2011) 1e6 3 performed, without the need to turn a tap, which is usually necessary with the traditional thoracentesis devices. The proper size and the material makes this new percutaneous catheter more adaptive to patient’s chest, even in case of a posterior placement, and reduces any risk of possible skin decubitus, wound infection and cutaneous bleeding. UNICOÒ, in our experience, results to be more comfortable if compared to another small-bore catheter system we used until now (PleurocathÒ,Prodimed, Neuilly-enThelle, France). In case of long in situ...

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Percutaneous small-bore catheter - 4

4 P.L. Filosso et al. / EJSO xx (2011) 1e6 Figure 3. A: the extended line connection to the placed drainage allows the patient to easily move from his bed with the chance to sit on the chair or at the table to eat and to perform respiratory physiotherapy; B-C-D: thoracentesis is very safe and easy to perform, due to the unidirectional valve of the system, and the uid collecting bag. or infection symptoms appear. Analgesic drugs ( per os CodeineParacetamol ) are administered according to the need of the patient. Results of TP and clinical patients evaluation We followed the American Thoracic...

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