Safety and Effectiveness of Palliative Tunneled Peritoneal Drainage Catheters in the Management of Refractory Malignant and Non-malignant Ascites

  • Jennifer A. Knight
  • Scott M. Thompson
  • Chad J. Fleming
  • Emily C. Bendel
  • Melissa J. Neisen
  • Newton B. Neidert
  • Andrew H. Stockland
  • Haraldur Bjarnason
  • David A. Woodrum
Clinical Investigation

Abstract

Purpose

To determine the safety and effectiveness of tunneled peritoneal catheters in the management of refractory malignant and non-malignant ascites.

Materials and Methods

An IRB-approved retrospective review was undertaken of patients who underwent ultrasound and fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant or non-malignant ascites between January 1, 2009, and March 14, 2014.

Results

A total of 137 patients (76 M/61 F, mean age 62.9 years) underwent tunneled peritoneal catheter placement for refractory malignant (N = 119; 86.9%) or non-malignant (N = 18; 13.1%) ascites. Technical success was 100% with no immediate complications. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection. The remaining complications included leakage at the dermatotomy site (N = 8), catheter dislodgement (N = 2), obstruction (N = 2), and groin pain (N = 2). Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 vs. 20 days; p < 0.01). Nine patients (6.6%) were lost to follow-up. Of the remaining 128 patients, 125 died and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 vs. 85 days; p < 0.0001).

Conclusions

Tunneled peritoneal drainage catheters are effective and relatively safe in the management of malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.

Keywords

Indwelling peritoneal catheter Abdominal ascites Drainage 

Notes

Compliance with Ethical Standards

Conflict of interest

Dr. Woodrum reports personal fees from Galil Medical and personal fees from CLS Medical, outside the submitted work.

Informed Consent

For this type of study, formal consent is not required. All study subjects had a Minnesota Research Authorization allowing use of medical records for research purposes.

References

  1. 1.
    Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut. 2006;55(Suppl 6):vi1–12.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Markman M. Palliation of symptomatic malignant ascites: an (often) unmet need. Oncology. 2012;82(6):313–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42(5):589–97.CrossRefPubMedGoogle Scholar
  4. 4.
    Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330(5):337–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Ross GJ, Kessler HB, Clair MR, et al. Sonographically guided paracentesis for palliation of symptomatic malignant ascites. AJR Am J Roentgenol. 1989;153(6):1309–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Runyon BA. Paracentesis of ascetic fluid: a safe procedure. Arch Intern Med. 1986;146:2259–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Mallory A, Schaefer JW. Complications of diagnostic paracentesis in patients with liver disease. JAMA. 1978;239:628–30.CrossRefPubMedGoogle Scholar
  8. 8.
    De Gottardi A, Thevenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Heptol 2009;7(8):906-909.CrossRefGoogle Scholar
  9. 9.
    Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg 2004;198(6):999-1011.CrossRefPubMedGoogle Scholar
  10. 10.
    Gines P, Arroyo V, Vagas V, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991;325(12):829-835.CrossRefPubMedGoogle Scholar
  11. 11.
    Stanley MM, Ochi S, Lee KK, et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med. 1989;321(24):1632–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Salerno F, Camma C, Enea M, et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133(3):825–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Copelan A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: Indications, contraindications, and patient work-up. Semin Interv Radiol. 2014;31(3):235–42.CrossRefGoogle Scholar
  14. 14.
    Stokes LS. Peritoneal management of malignant fluid collections. Semin Interv Radiol. 2007;24(4):398–408.CrossRefGoogle Scholar
  15. 15.
    Narayanan G, Pezeshkmehr A, Venkat S, et al. Safety and efficacy of the PleurX catheter for the treatment of malignant ascites. J Palliat Med. 2014;17(8):906–12.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Wong BC, Cake L, Kachuik L, et al. Indwelling peritoneal catheters for managing malignancy associated ascites. J Palliat Care. 2015;31(4):243–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Richard HM 3rd, Coldwell DM, Boyd-Kranis RL, et al. PleurX tunneled catheter in the management of malignant ascites. J Vasc Interv Radiol. 2001;12(3):373–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Tapping CR, Ling L, Razack A. PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success. Br J Radiol. 1013;2012(85):623–8.Google Scholar
  19. 19.
    Courtney A, Nemcek AA, Rosenberg S, et al. Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. J Vasc Interv Radiol. 2008;19(12):1723–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Fleming ND, Alvarez-Secord A, Von Gruenigen V, et al. Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manage. 2009;38(3):341–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Barnett TD, Rubins J. Placement of a permanent tunneled peritoneal drainage catheter for palliation of malignant ascites: a simplified percutaneous approach. J Vasc Interv Radiol. 2002;13(4):379–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Lungren MP, Charles CY, Stewart JK, et al. Tunneled pertioneal drainage catheter placement for refractory ascites: single-center experience in 188 patients. J Vasc Interv Radiol 2013;24(9):1303-1308.CrossRefPubMedGoogle Scholar
  23. 23.
    Solbach P, Honer Zu Siederdissen C, Taubert R, et al. Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis. Eur J Gastroenterol Hepatol. 2017;29(5):539–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Sacks D, McClenny TE, Cardella JF, et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.CrossRefPubMedGoogle Scholar
  25. 25.
    Lacy JH, Wieman TJ, Shively EH. Management of malignant ascites. Surg Gynaecol Obstet. 1984;159:397–412.Google Scholar
  26. 26.
    Rosenberg S, Courtney A, Nemcek AA, et al. Comparison of percutaneous management techniques for recurrent malignant ascites. J Vasc Interv Radiol. 2004;15(10):1129–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Bohn KA, Ray CE. Repeat large-volume paracentesis versus tunneled peritoneal catheter placement for malignant ascites: a cost-minimization study. AJR Am J Roentgenol. 2015;205(5):1126–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Jennifer A. Knight
    • 1
  • Scott M. Thompson
    • 2
  • Chad J. Fleming
    • 2
  • Emily C. Bendel
    • 2
  • Melissa J. Neisen
    • 2
  • Newton B. Neidert
    • 2
  • Andrew H. Stockland
    • 2
  • Haraldur Bjarnason
    • 2
  • David A. Woodrum
    • 2
  1. 1.Mayo Clinic School of MedicineRochesterUSA
  2. 2.Department of RadiologyMayo Clinic School of MedicineRochesterUSA

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