5.5: Indwelling Pleural Catheters and talc
Indwelling Pleural Catheters and talc
Your clinician may discuss the option of injecting liquid glue (a substance called ‘talc’ mixed with water) through an IPC once most of the fluid has been removed. Unlike other ways of using ‘talc’ this can be done as a day case without any stay in hospital.
It is considered in patients that don’t have a ‘trapped lung’ and is normally performed 10-14 days after the drain has been inserted and it has been confirmed there is no trapped lung. Prior to the ‘talc’ being inserted the IPC is normally drained at home more frequently to remove as much fluid as possible, often daily. Your doctors and nurses will talk to you about this option.
It has the same advantages as a standard IPC procedure, but importantly talc increases the chances of preventing the fluid building up. This may allow the IPC to be removed within the first few months after insertion. A study showed the chance of preventing fluid building up was almost twice as likely if talc was injected down the IPC. Another study showed that the improvement in breathlessness and quality of life from draining fluid and using the glue mixture (talc) is the same when the glue is given through a normal chest drain in a hospital setting (section 5.2 chest drain and talc) or through an IPC without any stay in Hospital.
Self-pleurodesis from an IPC without talc
IPCs are designed to remain in position for as long as they are needed. However, over time, having an IPC can eventually cause the lining of the lungs to stick together and prevent fluid from building up (‘self-pleurodesis’, see section 5.4 indwelling pleural catheters). Once the fluid stops building up, the IPC can usually be removed (see IPC removal section).
Self-pleurodesis occurs in about 1 in 5 (20%) patients.
Increasing the chance of pleurodesis with talc
Giving talc through an IPC can increase the chances of pleurodesis (and so allow the IPC to be removed). A research study showed that talc through an IPC led to a pleurodesis in nearly 1 in 2 (43%) patients.
Talc through an IPC can increase pleurodesis to nearly 1 in 2 (roughly 40-50%) patients
Advantages
- Uses glue to try and stop the fluid from building up
- One of the few ways of using glue that does not need a stay in hospital
- Increases the chances that the IPC can be removed in the first few months
Disadvantages
- Often limited to a maximal volume that can be drained during the procedure (could be important if there is a very large collection of fluid at the time)
- Requires intensive aftercare in the initial weeks after the procedure
- Daily drainages can be demanding
- Needs extra visits to hospital to have the talc procedure
- Talc cannot be used when the lung is trapped
| Will this be painful? | Injecting the glue through the drain can cause pain in some patients |
| Will I spend time in hospital? | Done as a ‘day case’. There is no stay in hospital |
| Will I need to come back to hospital? | Extra visits are needed to give the talc Long term drains can have problems over time like blockages and infection Any complications can lead to hospital visits |
| Will I need further procedures? | Further procedures are very unlikely, an IPC is a long-term solution to control the fluid, even if the glue doesn’t work the IPC will simply keep on draining The only exception is removal of the IPC at some point in the future (link to IPC removal section). |
| What if my lung is trapped | An IPC is an excellent solution to managing fluid and breathlessness if the lung is trapped but The glue will not work if the lung is trapped and should not be used in a trapped lung |
| Where can this be done? | IPCs are not performed in all hospitals but are becoming available in more and more hospitals |
| Is there any aftercare? | Long term drains require regular drainages at home which can be done by patients themselves, family members or community nurses |