Name of the Procedure:

Removal of Indwelling Tunneled Pleural Catheter with Cuff
Common name(s): Pleural catheter removal, Tunnelled pleural catheter extraction

Summary

This procedure involves the surgical removal of a previously installed tunneled pleural catheter, which is a long-term solution for draining excess fluid from the space around the lungs. The catheter has a cuff to secure it in place and prevent infection.

Purpose

The procedure addresses conditions where excess fluid accumulates in the pleural space, such as pleural effusion often due to cancer, heart failure, or infections. Expected outcomes include improving breathing, reducing symptoms, and minimizing risk of infections.

Indications

• Persistent pleural effusion
• Managed pleural disease requiring long-term drainage
• Catheter malfunction or infection
• Patient no longer requires fluid management through the catheter

Preparation

• Pre-procedure fasting is generally not required.
• Adjustments to medications, particularly blood thinners, may be necessary.
• Pre-procedure imaging (e.g., X-ray or ultrasound) to assess the position of the catheter.
• Routine blood tests to check coagulation status.

Procedure Description

1. The patient is positioned comfortably, usually lying on their side.
2. Local anesthesia is applied to numb the area around the catheter insertion point.
3. An incision is made to expose the cuff and catheter entry points.
4. The catheter is carefully loosened from the surrounding tissue.
5. The cuff is dissected and the catheter is gently pulled out.
6. Hemostasis is ensured, and the incision site is sutured and dressed.
7. The area is monitored for any signs of infection or complications.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is generally performed in a hospital setting or an outpatient surgical center.

Personnel

• Interventional radiologist or thoracic surgeon
• Surgical nurse
• Anesthesiologist or nurse who administers local anesthesia

Risks and Complications

• Infection at the site of removal
• Bleeding or hematoma formation
• Pneumothorax (collapsed lung)
• Pain or discomfort at the removal site
• Rarely, damage to surrounding tissues or organs

Benefits

• Elimination of discomfort or complications associated with the indwelling catheter.
• Improved quality of life by reducing the risk of pleural infections and inflammation.
• Immediate reduction of symptoms related to the catheter.

Recovery

• Keep the area clean and dry; follow specific wound care instructions.
• Mild discomfort can be managed with over-the-counter pain relievers.
• Avoid strenuous activities for a few days.
• Follow-up appointments may be necessary to monitor recovery and check for signs of complications.

Alternatives

• Continued use of the pleural catheter if appropriate
• Chemical pleurodesis to adhere the lung to the chest wall, preventing fluid buildup
• Surgical procedures such as pleurectomy in more severe cases
• Each alternative has its own risks and benefits which should be discussed with a healthcare provider.

Patient Experience

• The patient will feel localized numbness due to the anesthesia, with minimal discomfort during the procedure.
• Post-procedure soreness or mild pain around the site is common.
• Pain management strategies, like prescribed medications, will be discussed to ensure comfort.
• The patient will likely feel a significant relief of symptoms once the catheter is removed and the site heals.