I'm writing here for my mom, who is 90 and unable to participate directly. While her lung cancer is in remission, she has CHF and had a PleurX catheter placed a little over two months ago for right-side pleural effusion. At first, it caused significant enough pain that we considered removing it and returning to regular thoracentesis procedures, but the pain largely subsided after about a week. The pain returned a bit under a week ago and has been quite bad. Her cardiologist's presumption is that it slipped one way or another and is now in a troublesome position.
The options I'm aware of are either strong medication to address the pain or removal of the catheter. Pain medication is only partially helpful and leaves her disoriented. On the other hand, a decision for removal would be unfortunate, both because it's worked quite well up to now and because it's not entirely clear that she would survive without it.
I'm wondering if there's a middle option. Can a PleurX catheter be repositioned if its current position causes great pain? Alternatively, can it be removed and then — either immediately or after some short amount of time — be placed again in different or better position?
Are there any options to eliminate the cause of the pain other than removing the catheter?
Many thanks, in advance, for your response.
Sun, 03/28/2021 - 19:06
I'm so sorry your mom is going through this. Here is a good conversation about pleural effusions that I think will be helpful. For specific help with your mom, an interventional radiologist or interventional pulmonologist are doctors who work daily with these issues, giving them the best perspective and most experience at addressing individual problems. Together, an interventionist and her cardiologist may find a good course for your mom (2 heads are better than one).
I hope your mom finds relief soon.
Mon, 03/29/2021 - 08:20
Thanks so much for your response, Janine.
My understanding — based only upon my limited experience with this episode, what I've read, and what I've discussed with my mom's cardiologist — is that there's no such thing as "repositioning" the catheter, and that it's just hit or miss as to whether or not placement of a PleurX catheter is comfortable and tolerable. I'm hoping there's an option that addresses the cause of the pain that's short of simply removing the catheter.
Tue, 03/30/2021 - 10:53
I didn't ask before, has she been checked out for possible infection?
I've asked one of our faculty to comment. I know sometimes these catheters are repositioned because of blockage. It would depend on where it is and the condition of the patient. There might be issues with your mom's CHF that preclude it. I'll make sure I hear back from a faculty today.
Tue, 03/30/2021 - 16:59
While we're waiting for a faculty response, I will just say that I agree with Janine that when a pleurx catheter causes trouble that can't be remedied otherwise, removal and reinsertion is often the recommended option. In the case of an infection, antibiotics may resolve the problem, and a blockage may be cleared, but as is suggested in this article intractable pain often necessitates removal. I hope that a good plan can be developed by your mom's doctors, one that will relieve her pain while continuing to allow continued drainage of the effusion.
Jim C Forum Moderator
Wed, 03/31/2021 - 11:28
I heard back from Dr. West, "I don’t manage these catheters. I’ll try to find out from an interventional pulmonologist who manages them every day."
Perhaps your mom's oncologist could help. If you have the authority to speak with your mom's oncologist you could give them a call.
Thu, 04/01/2021 - 13:31
From Dr. West, "Dr. Jed Gorden, interventional pulmonologist at Swedish, says it's rare to need to take a PleurX out tude to pain. If it's related to draining the fluid (which I don't think it is in this person's case), you just drain less. Otherwise, you can take it out and try replacing, perhaps replacing it with a catheter cut shorter so it would be prone to irritate the pleura less...but this is uncommon enough that it's hard to predict whether that would solve the problem."
I hope this answers some of your questions and especially hope your mom is feeling better soon.
All the best,
Thu, 04/15/2021 - 08:20
Janine and Jim,
Thank you both so much for your very helpful responses.
No, there's been no infection nor blockage. My mom and her nurses are fortunately very careful about this, and I personally changed the dressing twice when alerted to my mother's oversite in allowing the dressing to become wet, as I know this can lead to infection if not addressed immediately.
Also, I can say by this point in time that the severe pain seems to be an issue that comes and then goes away. But the "goes away" part is only true if that sequence continues. As of right now, she's been in severe pain for going on 48 hours, and we never can be sure it will resolve on its own... until such time that it does.
You've both — with Dr. West's much appreciated input — provided a potentially very useful solution, although I realize there's no guarantee that it will help: "[R]emoval and reinsertion is often the recommended option", "perhaps replacing it with a catheter cut shorter so it would be prone to irritate the pleura less...." I will discuss this option with my mom's cardiologist — the medical professional that's been overseeing her CHF, pleural drainage and PleurX placement — at my next opportunity.
Thank you again, Jim and Janine, so very much.
Thu, 04/15/2021 - 09:09
Do you know if the nurse has tried draining less fluid? I don't know if you were able to read through the links. One of the problems with on and off pain is draining too much. It can happen when the build-up slows down but you're still trying to drain the same levels. I hope you find the culprit. You're doing so well by her and she is lucky to have you as her advocate.
All the best,
In reply to Jonathan, Do you know if the by JanineT Forum …
Mon, 04/19/2021 - 12:35
It's an interesting question. The schedule is one weekly drainage, and the doctor's order is not to drain any particular amount, but rather to drain however much fluid has accumulated since the last drainage. That said, the really perculiar thing is that sometimes a lot (350cc or more) is drained, and sometimes vertually zero is there to be drained. It may be that sometimes there are weeks when she retains fluid, and sometimes not. But this seems questionable, as her diet and medications remain the same.
Perhaps the times when an attempt is made but nothing is drained, this results in intermittant periods of pain. But I've also seen little correlation between the pain and the days when she is drained, so this doesn't fully make sense either.
Lastly, thanks for the kind words. So long as I can act to minimize her suffereing, I will. I just fear reaching a point where it becomes terrible and there's nothing to be done about it. Thankfully, we're not quite there yet.