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Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter.

Meier M, Mortensen FV, Madsen HH - Acta Radiol Open (2015)

Bottom Line: The technical success rate was 100%.Ten patients (50.0%) experienced minor adverse events.Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreatico-biliary Surgery, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Background: Malignant ascites is a pathological condition caused by intra- or extra-abdominal disseminated cancer. The object of treatment is palliation. In search of an effective and minimally invasive palliative treatment of malignant ascites placement of a permanent intra peritoneal catheter has been suggested.

Purpose: To evaluate our experiences with treatment of malignant ascites by implantation of a permanent PleurX catheter.

Material and methods: A retrospective study was conducted, comprising 20 consecutive patients with terminal cancer, who had a permanent PleurX catheter implanted because of malignant ascites in the period from February to November 2014. Using the patients' medical records, we retrieved data on patients and procedures.

Results: The technical success rate was 100%. Catheter patency was 95.2%, one catheter was removed due to dislocation. Ten patients (50.0%) experienced minor adverse events. No procedural difficulties were reported and there was no need for additional treatment of malignant ascites after catheter implantation. Median residual survival after catheter implantation was 27 days.

Conclusion: Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease.

No MeSH data available.


Related in: MedlinePlus

A step-by-step illustration of the implantation of the PleurX catheter: 1. Identification of accumulated ascites and an appropriate insertion site by US. In this case the right lower part of the abdomen was chosen for catheter insertion. 2. The PleurX catheter kit (CareFusion Catheter System, McGaw Park, IL, USA) is opened. 3. Disinfection of the skin. The procedure is sterile. 4. Local anesthesia of the skin and peritoneum with Lidocain 1%. 5. Two skin incisions are made. The first incision is made for guide wire insertion. The second incision is made 5–8 cm superior and medial to the first incision. This incision will be the catheter exit site. 6. Through the inferior incision the needle for the guide wire is inserted. 7. The guide wire is inserted. 8. The fenestrated end of the catheter is attached to the tunneler. The tip of the tunneler is bended just a bit and kept in direction toward the skin to avoid contact with intra-abdominal cavity when tunneling. 9. The tunneler and catheter are passed subcutaneously from the second incision down to and out through the first incision. The catheter is drawn until the polyester cuff lies inside the tunnel 1 cm from the second incision. 10. The catheter is placed subcutaneously. 11. The peel-away introducer is positioned over the guide wire. 12. The fenestrated end of the catheter is inserted into the introducer and positioned in the peritoneal cavity. 13. The peel-away introducer is removed leaving only the catheter into the peritoneal cavity. 14. The catheter is connected to a catheter bag and opened to ensure free flow of fluid. 15. The skin incisions are sutured and the catheter is sutured to the skin. The stitches are removed 10–12 days later.
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fig1-2058460115579934: A step-by-step illustration of the implantation of the PleurX catheter: 1. Identification of accumulated ascites and an appropriate insertion site by US. In this case the right lower part of the abdomen was chosen for catheter insertion. 2. The PleurX catheter kit (CareFusion Catheter System, McGaw Park, IL, USA) is opened. 3. Disinfection of the skin. The procedure is sterile. 4. Local anesthesia of the skin and peritoneum with Lidocain 1%. 5. Two skin incisions are made. The first incision is made for guide wire insertion. The second incision is made 5–8 cm superior and medial to the first incision. This incision will be the catheter exit site. 6. Through the inferior incision the needle for the guide wire is inserted. 7. The guide wire is inserted. 8. The fenestrated end of the catheter is attached to the tunneler. The tip of the tunneler is bended just a bit and kept in direction toward the skin to avoid contact with intra-abdominal cavity when tunneling. 9. The tunneler and catheter are passed subcutaneously from the second incision down to and out through the first incision. The catheter is drawn until the polyester cuff lies inside the tunnel 1 cm from the second incision. 10. The catheter is placed subcutaneously. 11. The peel-away introducer is positioned over the guide wire. 12. The fenestrated end of the catheter is inserted into the introducer and positioned in the peritoneal cavity. 13. The peel-away introducer is removed leaving only the catheter into the peritoneal cavity. 14. The catheter is connected to a catheter bag and opened to ensure free flow of fluid. 15. The skin incisions are sutured and the catheter is sutured to the skin. The stitches are removed 10–12 days later.

Mentions: Prior to the procedure accumulation of MA was identified by computed tomography (CT) or ultrasonography (US). Contents from the PleurX catheter kit was used in the following: Lidocaine 1% was injected subcutaneously at the site of desired drain insertion and a skin incision was made. A second incision was made 5–8 cm superior and medial to the first. Under US guidance a J-Tip guide wire was inserted into the peritoneal cavity by an 18 Gauge (G) needle through the inferior incision. The needle was removed, leaving the guide wire in place. The 15.5 G fenestrated peritoneal catheter was tunneled subcutaneously from the superior to the inferior incision. A 16 G peel-away introducer was passed over the guide wire, and the guide wire was removed. The fenestrated end of the catheter was inserted into the peel-away introducer and further into the peritoneal cavity, and the peel-away introducer was subsequently removed. Both incisions were sutured, and the catheter was sutured to the skin, connected to the catheter bag, and opened to ensure flow of free fluid. No prophylactic antibiotics were given. The implantation of the PleurX catheter is illustrated step-by-step in Fig. 1.Fig. 1.


Malignant ascites in patients with terminal cancer is effectively treated with permanent peritoneal catheter.

Meier M, Mortensen FV, Madsen HH - Acta Radiol Open (2015)

A step-by-step illustration of the implantation of the PleurX catheter: 1. Identification of accumulated ascites and an appropriate insertion site by US. In this case the right lower part of the abdomen was chosen for catheter insertion. 2. The PleurX catheter kit (CareFusion Catheter System, McGaw Park, IL, USA) is opened. 3. Disinfection of the skin. The procedure is sterile. 4. Local anesthesia of the skin and peritoneum with Lidocain 1%. 5. Two skin incisions are made. The first incision is made for guide wire insertion. The second incision is made 5–8 cm superior and medial to the first incision. This incision will be the catheter exit site. 6. Through the inferior incision the needle for the guide wire is inserted. 7. The guide wire is inserted. 8. The fenestrated end of the catheter is attached to the tunneler. The tip of the tunneler is bended just a bit and kept in direction toward the skin to avoid contact with intra-abdominal cavity when tunneling. 9. The tunneler and catheter are passed subcutaneously from the second incision down to and out through the first incision. The catheter is drawn until the polyester cuff lies inside the tunnel 1 cm from the second incision. 10. The catheter is placed subcutaneously. 11. The peel-away introducer is positioned over the guide wire. 12. The fenestrated end of the catheter is inserted into the introducer and positioned in the peritoneal cavity. 13. The peel-away introducer is removed leaving only the catheter into the peritoneal cavity. 14. The catheter is connected to a catheter bag and opened to ensure free flow of fluid. 15. The skin incisions are sutured and the catheter is sutured to the skin. The stitches are removed 10–12 days later.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4548747&req=5

fig1-2058460115579934: A step-by-step illustration of the implantation of the PleurX catheter: 1. Identification of accumulated ascites and an appropriate insertion site by US. In this case the right lower part of the abdomen was chosen for catheter insertion. 2. The PleurX catheter kit (CareFusion Catheter System, McGaw Park, IL, USA) is opened. 3. Disinfection of the skin. The procedure is sterile. 4. Local anesthesia of the skin and peritoneum with Lidocain 1%. 5. Two skin incisions are made. The first incision is made for guide wire insertion. The second incision is made 5–8 cm superior and medial to the first incision. This incision will be the catheter exit site. 6. Through the inferior incision the needle for the guide wire is inserted. 7. The guide wire is inserted. 8. The fenestrated end of the catheter is attached to the tunneler. The tip of the tunneler is bended just a bit and kept in direction toward the skin to avoid contact with intra-abdominal cavity when tunneling. 9. The tunneler and catheter are passed subcutaneously from the second incision down to and out through the first incision. The catheter is drawn until the polyester cuff lies inside the tunnel 1 cm from the second incision. 10. The catheter is placed subcutaneously. 11. The peel-away introducer is positioned over the guide wire. 12. The fenestrated end of the catheter is inserted into the introducer and positioned in the peritoneal cavity. 13. The peel-away introducer is removed leaving only the catheter into the peritoneal cavity. 14. The catheter is connected to a catheter bag and opened to ensure free flow of fluid. 15. The skin incisions are sutured and the catheter is sutured to the skin. The stitches are removed 10–12 days later.
Mentions: Prior to the procedure accumulation of MA was identified by computed tomography (CT) or ultrasonography (US). Contents from the PleurX catheter kit was used in the following: Lidocaine 1% was injected subcutaneously at the site of desired drain insertion and a skin incision was made. A second incision was made 5–8 cm superior and medial to the first. Under US guidance a J-Tip guide wire was inserted into the peritoneal cavity by an 18 Gauge (G) needle through the inferior incision. The needle was removed, leaving the guide wire in place. The 15.5 G fenestrated peritoneal catheter was tunneled subcutaneously from the superior to the inferior incision. A 16 G peel-away introducer was passed over the guide wire, and the guide wire was removed. The fenestrated end of the catheter was inserted into the peel-away introducer and further into the peritoneal cavity, and the peel-away introducer was subsequently removed. Both incisions were sutured, and the catheter was sutured to the skin, connected to the catheter bag, and opened to ensure flow of free fluid. No prophylactic antibiotics were given. The implantation of the PleurX catheter is illustrated step-by-step in Fig. 1.Fig. 1.

Bottom Line: The technical success rate was 100%.Ten patients (50.0%) experienced minor adverse events.Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreatico-biliary Surgery, Aarhus University Hospital, Aarhus, Denmark.

ABSTRACT

Background: Malignant ascites is a pathological condition caused by intra- or extra-abdominal disseminated cancer. The object of treatment is palliation. In search of an effective and minimally invasive palliative treatment of malignant ascites placement of a permanent intra peritoneal catheter has been suggested.

Purpose: To evaluate our experiences with treatment of malignant ascites by implantation of a permanent PleurX catheter.

Material and methods: A retrospective study was conducted, comprising 20 consecutive patients with terminal cancer, who had a permanent PleurX catheter implanted because of malignant ascites in the period from February to November 2014. Using the patients' medical records, we retrieved data on patients and procedures.

Results: The technical success rate was 100%. Catheter patency was 95.2%, one catheter was removed due to dislocation. Ten patients (50.0%) experienced minor adverse events. No procedural difficulties were reported and there was no need for additional treatment of malignant ascites after catheter implantation. Median residual survival after catheter implantation was 27 days.

Conclusion: Implantation of a permanent PleurX catheter is a minimally invasive and effective procedure with only minor adverse events and a high rate of catheter patency in patients with malignant ascites caused by terminal cancer disease.

No MeSH data available.


Related in: MedlinePlus