Implantable access system for prolonged intrapleural immunotherapy

Our plain-English summary of Implantable access system for prolonged intrapleural immunotherapy, by P. Driesen, C. Boutin, J.R. Viallat, et al (The European Respiratory Journal, 1994).

The study

• Authors: P. Driesen, C. Boutin, J.R. Viallat, P.H. Astoul, J.P. Vialette, J. Pasquier
• Journal: The European Respiratory Journal
• Published: 1994;7(10):1889-92
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe our experience using an implantable Port-A-Cath access system for intrapleural administration of gamma-interferon (gamma-IFN) in malignant mesothelioma patients. Twenty nine patients, with histologically proven malignant mesotheliomas were included in this study. To avoid complications the device was implanted in a subcutaneous pocket, and the catheter was connected via a tunnel. Also, a suction drain was installed in the pocket after placement. This procedure greatly reduced the high infection rate (64%) encountered with conventional open chest tubes. Patients' tolerance was excellent and maintenance minimal. In our opinion, the Port-A-Cath system is the most suitable device for intra-cavitary long-term therapy of malignant pleural effusions.

In plain English

This technical note from Marseille, France, described the Port-A-Cath, a device implanted under the skin. It was used to give repeated doses of gamma-interferon into the pleural cavity (the space between the lung and chest wall linings) of 29 patients with histologically proven malignant mesothelioma. The authors adopted it because 64% of their initial 18 patients treated through open chest tubes had developed local infection. The article did not study asbestos exposure. Of the 29 patients, 18 (62%) had no complications, four (14%) had temporary local swelling, and seven (24%) had local infection with pus. One of these seven developed an empyema, and six needed the device removed. The authors wrote that all seven infections occurred before March 1990, but their table lists three infected patients whose devices were placed in March 1990. From then on, the team routinely placed a suction drain in the skin pocket, and no haematoma or infection was seen in the remaining 14 patients. The authors attributed the infections probably to haematoma around the device. They recommended the device for prolonged intrapleural medication.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Technical note describing a series of patients who received an implanted access device
• Who was studied: 29 patients with histologically proven malignant mesothelioma (26 males, 3 females; reported mean age 60 years), treated in Marseille, France, as part of a multicentre gamma-interferon study begun in 1989. Devices were placed from November 1989 onward.
• Exposure: Not an asbestos exposure study. The intervention was an implanted Port-A-Cath device used to give 40 million international units of gamma-interferon into the pleural cavity twice a week for eight weeks. The article gives no information on the patients' asbestos exposure.
• Main results:
  • No complications occurred in 18 of the 29 patients (62%).
  • In four patients (14%), device placement was followed by transient local oedema.
  • In seven patients (24%), device placement was complicated by local suppuration. One of these patients developed an empyema.
  • In six of the seven infected patients, the device had to be removed.
  • The authors stated that all seven infections occurred before March 1990. Their Table 1, however, lists three infected patients whose devices were placed in March 1990, with infection diagnosed four, six and five weeks after placement.
  • After the routine use of a pocket drain began, no local haematoma or infection was observed in any of the remaining 14 patients.
  • Before the device was used, local infection occurred in 64% of the authors' initial 18 patients treated with open chest tubes.
• The authors' conclusion: The authors attributed the infections probably to haematoma around the device. Based on their experience, they recommended the Port-A-Cath system for prolonged administration of intrapleural medication.
• Limitations the authors state:
  • The authors did not see blockage of the catheter tip by a fibrinous sheath. They noted that devices in their study stayed in place for a median of 8 weeks, compared with 22 weeks in another series where that problem occurred.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Immunotherapy, Malignant Mesothelioma, Pleural Effusion.

Related studies

• Pulmonary complications of peritoneal access catheters — G.R. Weiss (1985)
• Intrapleural recombinant IL-2 in passive immunotherapy for malignant pleural effusion — P. Astoul, J.R. Viallat, et al. (1993)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital — R.C. Boshuizen, S. Onderwater, et al. (2013)
• In vitro effects of recombinant human interferon gamma on human mesothelioma cell lines — L. Zeng, A. Buard, et al. (1993)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)

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