First Line instead of Last Step
First line instead of last step:
When is the tunneled pleural catheter the first choice?
Interview with Dr. Baum:
Malignant pleural effusion, unclear prognosis, patients with multiple punctures. And then, at some point, the decision to insert a catheter. This scenario is part of everyday life in many hospitals. Yet treatment could be much more predictable.
Dr. Daniel Baum, thoracic surgeon at the Coswig Lung Center, explains in an interview why the tunneled pleural catheter is the logical first-line decision for him in certain situations and how both the care team and the patients benefit from it.
Dr. Baum, when will you be using a tunneled pleural catheter be considered as an initial measure?
Dr. Daniel Baum:
We don’t actively use the term “first-line therapy” internally, but yes, there are situations in which we know immediately on first contact with the patient: This will be a chronic recurrent effusion. For example, in the case of pleural carcinomatosis or cardiac-related effusions.
If a tethered lung is found intraoperatively or an obvious pleural carcinomatosis is found during a diagnostic thoracoscopy and long-term drainage therapy is foreseeable, we implant the indwelling catheter directly in order to spare the patient an additional procedure.
How do you actually proceed if the diagnosis is made intraoperatively?
Dr. Daniel Baum:
If we see during a thoracoscopy that the lung is “tied up” or that the effusion will recur, we implant an indwelling pleural catheter directly. The aim is to spare the patient an additional procedure.
What is your experience of the procedure itself?
Dr. Daniel Baum:
Implantation is a short procedure with a very short hospital stay in most cases. Postoperative pain is generally minimal. Other procedures are significantly more complex and involve greater stress for the patient.
Which complications do you see more frequently: with punctures or with catheters?
Dr. Daniel Baum:
Infections do occur, but this is not a major problem. We see more complications with multiple punctures, such as bleeding or lung injuries. The catheter is safer in many cases.
How does the care of of the patients after discharge?
Dr. Daniel Baum:
Very good. If the discharge management works, the aftercare also runs smoothly. We also employ some ewimed training staff as
nursing specialists.
What would you recommend to colleagues from other disciplines?
Dr. Daniel Baum:
Punctures are stressful, risky and logistically complex. If it is clear that there is a malignant or cardiac effusion with a risk of recurrence, the Catheter implantation should be seriously considered as an initial measure.
Conclusion
First-line means sparing the patient unnecessary interventions, using resources efficiently and following a clear treatment path at an early stage.
In most cases, we opt for a drainage solution – either temporary or permanent, depending on the situation.
Take the opportunity to make a first-line decision:
Recommend, refer or implant, depending on the specialist group and clinical situation.
Would you like to structure the care in your clinic or seek advice? Our team will be happy to support you personally.
