32550 Insertion of indwelling tunneled pleural catheter with cuff

Name of the Procedure:

Insertion of Indwelling Tunneled Pleural Catheter with Cuff Commonly referred to as: Tunneled Pleural Catheter Insertion, Pleural Catheter Placement, PleurX Catheter Insertion

Summary

This procedure involves placing a special tube (catheter) into the pleural space—the area between the lungs and the chest wall—to help drain pleural fluid that accumulates due to conditions like cancer or chronic infections.

Purpose

The primary aim is to relieve symptoms such as shortness of breath and chest discomfort caused by fluid buildup in the pleural space. It also helps to manage recurrent pleural effusions, allowing for regular fluid drainage at home.

Indications

• Recurrent pleural effusion, often due to malignancies
• Chronic pleural infections
• Symptomatic relief from pleural fluid accumulation
• Patients who are not candidates for more invasive surgical procedures

Preparation

• Patients may need to fast for a few hours before the procedure.
• Blood tests or imaging studies (e.g., chest X-ray, ultrasound) may be required to assess the pleural fluid.
• Adjustments to medications, particularly blood thinners, may be necessary under the guidance of a healthcare provider.

Procedure Description

1. The patient is positioned, usually lying on their back or side.
2. Local anesthesia is administered to numb the insertion site; sedation may be provided.
3. An incision is made, and a pathway (tunnel) is created under the skin to position the catheter.
4. The catheter is carefully inserted into the pleural space and tunneled through the created pathway.
5. A cuff on the catheter helps secure it in place, preventing infection.
6. The other end of the catheter is externalized and secured, allowing for periodic drainage.

Duration

Typically takes about 30 to 60 minutes.

Setting

Performed in a hospital, outpatient clinic, or specialized procedure suite.

Personnel

• Interventional radiologist or thoracic surgeon
• Assisting nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Bleeding
• Infection
• Pneumothorax (collapsed lung)
• Pain or discomfort at the insertion site
• Catheter malfunction or blockage

Benefits

• Provides significant symptom relief from pleural effusions.
• Allows patients to manage pleural fluid buildup at home.
• Minimally invasive compared to surgical alternatives.

Recovery

• Monitoring for a few hours post-procedure.
• Instructions on how to care for and drain the catheter at home.
• Follow-up appointments to assess the site and system functionality.
• Most patients can resume normal activities within a few days but should avoid heavy lifting or strenuous activity.

Alternatives

• Repeated thoracentesis (manual fluid drainage)
• Chemical pleurodesis (chemical injection to adhere lung to chest wall)
• Video-assisted thoracic surgery (VATS) for pleural effusion
• Each option has varying degrees of invasiveness, risks, and convenience.

Patient Experience

• Local anesthesia minimizes pain during the procedure, though some pressure or discomfort may be felt.
• Post-procedure, patients may experience mild discomfort around the insertion site which can be managed with pain medications.
• Detailed instruction is provided for home care to ensure the patient's comfort and the catheter's functionality.