5.6: Thoracoscopy and Indwelling Pleural Catheter (IPC)

This is a longer procedure (60min) and a more complex procedure. Sometimes this procedure is done under a general anaesthetic (patients are asleep) and sometimes it is done with sedation (patients are sleepy and relaxed but still awake). The doctor makes a small cut in the skin and makes a small tunnel down to the fluid. All the fluid is removed through a camera and suction tube. When the fluid has been drained away, an indwelling pleural catheter (IPC) can be inserted.

This might be considered when there is evidence that the lung is trapped either before the thoracoscopy or during the thoracoscopy.

At the end of the procedure, the IPC will be connected to standard chest drain bottle for a few hours after the thoracoscopy but then disconnected and ‘capped off’ if the doctors and nurses are happy with the recovery after the procedure. Sometimes both talc and an IPC are performed during a thoracoscopy and this is the subject of ongoing research.

Advantages
  • Very good at relieving breathlessness caused by the fluid
  • All the fluid is removed during the procedure (is not limited by a maximal volume that can be drained). This might offer the most immediate and maximal improvement in breathlessness
  • Can allow same day discharge from Hospital
  • Having an IPC can reduce the need for future procedures to manage fluid if the fluid were to come back.
Disadvantages
Will this be painful? The indwelling pleural catheter can cause some discomfort whilst the drain is there and other complications in a small number of patients
Will I spend time in hospital? Having an IPC during the thoracoscopy might allow this to be done as a ‘day case’ procedure with no overnight stay in Hospital
Will I need to come back to hospital? The IPC will need draining by community nurses or trained family/carers 3 or more times per week initially and will likely need removing at some point in the future in a hospital setting
Will I need further procedures? Further procedures are very unlikely, except for removal of the IPC at some point in the future
What if my lung is trapped? An IPC is an excellent solution to managing fluid and breathlessness if the lung is trapped
Where can this be done? Thoracoscopy and IPC at the same time is a specialised test that is performed at selected hospitals
Is there any aftercare? Once discharged from hospital the community nurses will come in to drain the IPC and remove the sutures.
Next - 6: Summary of treatments for malignant pleural effusions