Tunnelled indwelling pleural catheters inserted post thoracoscopy

Introduction: Were we to be aware at thoracoscopy which patients would benefit from a tunnelled indwelling pleural catheter (TIPC), we could perform both procedures simultaneously thus simplifying the treatment pathway for the patient and potentially relieving breathlessness earlier. Aim: To evaluate the frequency of post-thoracoscopy TIPC insertion and describe this cohort of patients. Method: Data was collected regarding the diagnosis, duration of TIPCs and complications for patients who underwent thoracoscopy and TIPC insertion at the Royal Gwent Hospital from October 2010 to November 2019. Results: 349 patients had thoracoscopy during the time period whilst 151 patients had TIPCs inserted, of which 51 (34%) were inserted post thoracoscopy and 4 at thoracoscopy. The mean time between thoracoscopy and TIPC insertion was 65 days. 36% of all thoracoscopy patients with mesothelioma had a TIPC, compared to 16% of patients with other malignancies. 21 TIPCs were inserted within 30 days of thoracoscopy; of these, 13 had mesothelioma, 9 had talc at thoracoscopy, and 10 had visible non-expandable lung (NEL) at thoracoscopy. 20 patients had their TIPC removed due to pleurodesis, and 4 due to localised infection. The average duration of a non-infected TIPC was 105 days. 26 (47%) patients died with a TIPC in situ with an average time from insertion to death of 109 days. Conclusion: The 21 patients who had a TIPC inserted within 30 days of thoracoscopy would have benefitted most from having simultaneous procedures. We could consider inserting a TIPC at thoracoscopy when there is a high index of suspicion for both mesothelioma and NEL. The availability of pleural manometry may aid this decision.