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An indwelling pleural catheter is a thin tube left in the chest so that fluid caused by cancer can be drained at home, by a nurse, a relative or yourself, using vacuum bottles. Drain as often as your breathing needs, or daily if the aim is for the fluid to stop; slow or stop if it hurts; and call the team for fever, redness, a damaged tube, or worse breathlessness when nothing drains.
The BTS pleural guideline (2023) offers people with a malignant pleural effusion and no known non-expandable lung a choice of IPC or pleurodesis first line (conditional), and favours an IPC where more than a quarter of the lung will not re-expand. After insertion every patient should be referred to the community nursing team, and patients and relatives supported to drain and keep a drainage diary (good practice points). Drainage uses the manufacturer's vacuum bottles and procedure; the usual starting frequency is three times a week. Daily drainage raises the rate of spontaneous pleurodesis and shortens time to catheter removal (ASAP: 47% vs 24% with every-other-day drainage; AMPLE-2: 44.2% vs 15.9% at 6 months against symptom-guided drainage) without improving breathlessness, so BTS recommends daily drainage only where removal is a priority (conditional) and tells patients they do not need daily drainage to control breathlessness (strong, by consensus). About 500 mL is usually drained at a time, up to 1500 mL, slowed or stopped for pain or cough. Infection (pleural infection 3.2% to 5%) usually responds to antibiotics without removing the catheter (ATS/STS/STR, weak). Removal is considered after less than 50 mL on three consecutive drainages with no reaccumulation on imaging. Talc instilled through the IPC doubles pleurodesis at 35 days (43% vs 23%, IPC-PLUS) and BTS offers it where removal matters (conditional, by consensus).
Why: Both work for breathlessness; the catheter avoids a hospital stay but stays in the body, which matters to some people.
“Patients without known non-expandable lung should be offered a choice of indwelling pleural catheter (IPC) or pleurodesis as first-line intervention in the management of MPE.”
British Thoracic Society 2023 · Conditional
Why: Someone needs to check the wound and help with the first drainages at home.
“All patients who have had an IPC inserted should be referred to the community nursing team on discharge for an early assessment of the wound site, symptom control, support with IPC drainage and removal of sutures.”
British Thoracic Society 2023 · Good practice point (ungraded)
Why: Draining at home without waiting for a nurse gives people more independence, and the diary shows when fluid is slowing down.
“Patients and their relatives should be supported to perform community drainage and complete a drainage diary if they feel able to do so, to promote independence and self-management.”
British Thoracic Society 2023 · Good practice point (ungraded)
Why: Each catheter system has its own valve and bottle, and the pack's instructions keep the procedure clean and air-tight.
“All manufacturers' drainage packs contain comprehensive procedure guidelines which should be adhered to.”
British Thoracic Society 2023 · Clinical practice point (ungraded)
Why: Draining every day makes the lung lining stick together sooner, but it does not make breathing better than draining when needed.
“Drainage frequency should be guided by patient symptoms, unless aiming for pleurodesis in those with expansile lungs, in which case IPC drainage should be as frequent as possible (daily) as tolerated by the patient.”
British Thoracic Society 2023 · Clinical statement (ungraded); see grades for the BTS guideline recommendation
Why: Pain towards the end of drainage often means the lung cannot expand to fill the space, and pulling harder does harm.
“Usually around 500 mL are drained, but up to 1500 mL pleural fluid may be drained”
British Thoracic Society 2023 · Grade C (the 1500 mL ceiling, as cited by the statement); the statement calls the figure arbitrary
Why: The main long-term risk is infection getting in along the tube.
“After both sutures are removed, patients can have a bath and swim, although care should be taken to keep the IPC site clean and dry, such as with a waterproof dressing and prompt changing of the dressing should it get wet.”
British Thoracic Society 2023 · Clinical statement (ungraded)
Why: These can be signs of infection or a displaced tube, which are treatable if caught early.
“Contact your doctor if you have increasing chest pain, fever or any redness around the IPC, or if you are concerned the IPC has become dislodged.”
British Thoracic Society 2023 · Patient information (ungraded)
Why: Most catheter infections clear with antibiotics and the catheter can stay.
“Antibiotic therapy should be commenced if IPC-related infection is suspected.”
British Thoracic Society 2023 · Clinical practice point (ungraded); ATS/STS/STR 2018: weak recommendation to treat with antibiotics and not remove the catheter
Why: The tube may be blocked or the fluid may have split into pockets, which the team can treat.
“Secondary care advice should be sought in the event drainage stops in the presence of worsening breathlessness.”
British Thoracic Society 2023 · Clinical practice point (ungraded)
Why: An open catheter lets air into the chest and fluid out.
“In the rare event of damage to the catheter or its valve the catheter should be clamped to avoid air entry to the pleural cavity or leakage of pleural fluid.”
British Thoracic Society 2023 · Appendix 9 troubleshooting (ungraded)
Why: The lining may have sealed itself, and the tube can then come out as a day case.
“If the catheter drains less than 50 mL on three consecutive occasions the respiratory team should be contacted for consideration of catheter removal.”
British Thoracic Society 2023 · Clinical practice point (ungraded)
Why: Body fluids during some cancer drugs can carry drug residues, so some areas collect them as clinical waste.
“If the patient is not receiving chemotherapy/immunotherapy the drainage fluid can be disposed of down the toilet and the bottle with the household rubbish.”
British Thoracic Society 2023 · Appendix 9 (ungraded)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
The BTS guideline for pleural disease (2023) with the BTS clinical statement on pleural procedures (2023) is the most detailed current standard for home IPC care, and agrees with the ATS/STS/STR guideline (2018) that an IPC and pleurodesis are both reasonable first choices, that an IPC is preferred when the lung will not re-expand, and that catheter infections are treated with antibiotics without removing the catheter. The one real choice is drainage frequency: two randomised trials show that daily drainage roughly doubles spontaneous pleurodesis without improving breathlessness, so BTS ties daily drainage to the patient's own priority (removal of the catheter) and says plainly that it is not needed for symptom control.
British Thoracic Society 2023 · British Thoracic Society 2023 · American Thoracic Society, Society of Thoracic Surgeons, Society of Thoracic Radiology 2018 · American Thoracic Society 2017 · The Lancet Respiratory Medicine 2018
Where it differs: Drains every day from the start, aiming for the pleura to seal and the catheter to come out.
Evidence: ASAP: autopleurodesis 47% vs 24% with every-other-day drainage, median 54 vs 90 days, no difference in adverse events or quality of life. AMPLE-2: spontaneous pleurodesis 44.2% vs 15.9% at 6 months against symptom-guided drainage, no difference in breathlessness, better EQ-5D. BTS: conditional recommendation where removal is a priority.
American Thoracic Society 2017 · The Lancet Respiratory Medicine 2018 · British Thoracic Society 2023
Where it differs: Drains only when breathlessness returns.
Evidence: Breathlessness was no worse than with daily drainage in AMPLE-2; fewer drainages and lower cost. BTS: patients should be told they do not need daily drainage to control symptoms (strong, by consensus).
The Lancet Respiratory Medicine 2018 · British Thoracic Society 2023
Where it differs: A fixed regular schedule between the two.
Evidence: BTS clinical statement calls three times a week the usual starting frequency; every-other-day was the standard arm in ASAP and gave less pleurodesis than daily drainage.
British Thoracic Society 2023 · American Thoracic Society 2017
Where it differs: Instils 4 g of talc slurry through the catheter as an outpatient once it is clear the lung re-expands.
Evidence: IPC-PLUS: pleurodesis at day 35 in 43% with talc vs 23% with placebo, no excess adverse events. BTS 2023: offer where pleurodesis and removal matter to the patient or clinician (conditional, by consensus).
New England Journal of Medicine 2018 · British Thoracic Society 2023
Where it differs: Some NHS trusts use flutter bags for community patients who find vacuum drainage uncomfortable; underwater seal drains are used for inpatients to save cost or to drain an infected effusion.
Evidence: Named by the BTS clinical statement (appendix 9) as local practice (Torbay and South Devon NHS Foundation Trust); the licensed method is the manufacturer's vacuum bottle. No comparative evidence was found.
People with fluid around the lung from cancer can have a small tube left in to drain it at home. In two randomised trials, draining it every day rather than less often doubled or more than doubled how often the fluid stopped for good, without making breathlessness worse. The British guideline now recommends it where removing the tube matters to the person; how often it is offered is not measured.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Daily drainage where IPC removal is a priority “Where IPC removal is a priority, daily IPC drainages are recommended to offer increased rates of pleurodesis when compared with less frequent drainages of symptom-guided or alternate drainage regimes.” | Conditional | British Thoracic Society 2023 |
| Daily drainage is not needed to control breathlessness “Patients should be advised that they do not require daily drainage to control symptoms of breathlessness and chest pain if they wish to opt for a less intensive regime.” | Strong (by consensus) | British Thoracic Society 2023 |
| Talc via the IPC where pleurodesis matters “Instillation of talc via an IPC should be offered to patients with expandable lung where the clinician or patient deems achieving pleurodesis and IPC removal to be important.” | Conditional (by consensus) | British Thoracic Society 2023 |
| IPC rather than talc when more than 25% of the lung does not re-expand “In patients with radiologically significant (>25%) non-expandable lung requiring intervention for a symptomatic MPE, current evidence suggests the use of an IPC rather than talc pleurodesis.” | Good practice point (ungraded) | British Thoracic Society 2023 |
| IPC or pleurodesis for expandable lung; IPC for non-expandable lung; antibiotics without removal for IPC infection “treating IPC-associated infections with antibiotics and not removing the catheter” | Weak recommendations (GRADE) | American Thoracic Society, Society of Thoracic Surgeons, Society of Thoracic Radiology 2018 |
| Consider removal after three low drainages and no reaccumulation “Consider removal of IPCs when <50 mL are drained on three consecutive occasions and there is an absence of symptoms of fluid reaccumulation and no substantial residual pleural effusion on imaging.” | Clinical statement (ungraded) | British Thoracic Society 2023 |
| Infection rate and response to antibiotics “IPC related pleural infections carry a 0.29% mortality rate, but the majority (94%) respond to antibiotics treatment.” | Complications table (observational studies) | British Thoracic Society 2023 |
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