Congress Abstracts 2005

93

MALIGNANT PLEURAL EFFUSIONS: ADVANTAGES OF PALLIATIVE OUTPATIENT MANAGEMENT WITH THE PLEURX CATHETER. Lauren Drys-dale, RN, BSN, and Lisa Cederbaum, RN, BSN, Memorial Sloan-Kettering Cancer Center, New York, NY.

Malignant pleural effusion (MPE) is often an end stage complication of cancer, and most patients die within six months of diagnosis. In these patients, palliative therapy is considered the primary treatment plan. With the intervention of skilled nurses, patients are able to manage their MPE at home, thus increasing their quality of life and allowing them to maintain a sense of independence.

MPE is the accumulation of excess fluid in the pleural space. For those suffering with MPE, fluid accumulation results in chest discomfort, shortness of breath, cough, pleuritic pain, and often recurs post initial drainage. Removal of this fluid traditionally required in-patient admission and painful treatments including therapeutic thoracentesis and chemical pleurodesis. Recently, the trend has shifted towards placement of small-bore indwelling catheters, allowing for outpatient management. Nursing care of this catheter is relatively simple and care is easily transferred from nurse to patient or caregiver, thus facilitating a faster discharge to home.

The nurse’s primary role is educating the patient and caregiver and providing instruction of proper drainage technique. The nurse provides demonstration of dressing change and drainage, then, requires return demonstration from patient and caregiver to ensure understanding and compliance. Supplemental to the one on one patient education, an instructional booklet has been created for the patients to have written information for reference. The support paradigm shifts from recurrent hospital admissions to placement of semi-permanent chest drainage and outpatient management.

For MPE that recur rapidly, the placement of a small-bore catheter, such as the Pleurx^®, is the treatment of choice. It permits a sense of independence for the patient allowing them to live their lives and decrease hospital visits when their time at home with family is most precious. Allowing the patient to return home with a less aggressive treatment and limited or no hospital stay defines the type of care oncology nurses have always embraced.

The Pleurx^® catheter is an excellent choice in managing MPE. The Pleurx^® system allows for intermittent self-drainage of MPE, thus eliminating admissions for hospital management.