Pulmonary complications of peritoneal access catheters

Our plain-English summary of Pulmonary complications of peritoneal access catheters, by G.R. Weiss (Journal of Clinical Oncology, 1985).

The study

• Author: G.R. Weiss
• Journal: Journal of Clinical Oncology
• Published: 1985;3(12):1690-1
• Type of article: Case report, Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This letter to the editor described one patient, a 37-year-old man with advanced pleural and peritoneal malignant mesothelioma. A totally implantable peritoneal access catheter (Port-A-Cath) was placed to drain recurrent massive malignant ascites (abdominal fluid) and to give chemotherapy into the abdomen. One month after surgery, 4,100 mL of ascites were drained through the catheter into an evacuated bottle over 30 minutes. About 12 hours later he developed sudden severe respiratory distress. Chest x-rays showed diffuse opacification of both lungs, a right pneumothorax (collapsed lung, 10%), a small left pneumothorax and a right pleural effusion. He was treated with a chest tube, diuresis and oxygen by CPAP, improved, and was discharged one month after admission. The author wrote that the cause was obscure but that the timing suggested a causal relationship. The author postulated that rapid fluid shifts and negative pressure reached the chest, causing noncardiogenic pulmonary edema and pneumothorax. The author suggested that very rapid fluid removal may represent a potential hazard for patients with implanted catheters. The letter did not discuss asbestos exposure.

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: Case report (letter to the editor describing a single patient)
• Who was studied: One 37-year-old man with advanced pleural and peritoneal malignant mesothelioma and recurrent massive malignant ascites, reported from The University of Texas Health Science Center at San Antonio
• Exposure: No asbestos exposure is described. The event studied was rapid drainage of ascites through an implanted peritoneal access catheter: 4,100 mL removed over 30 minutes using an 18 gauge Huber needle, an unvented intravenous administration set and a 2-liter evacuated bottle
• Main results:
  • After the catheter was first placed, the patient had acute respiratory failure, apparently due to pulmonary edema. It gradually responded to diuresis and oxygen by CPAP.
  • About 12 hours after the 4,100 mL drainage, the patient had a sudden onset of severe respiratory distress.
  • Arterial blood gases showed a PO2 of 30 mm Hg, a PCO2 of 30 mm Hg and a pH of 7.42.
  • Chest x-rays showed bilateral diffuse opacification of the lungs, a right pneumothorax (10%), a small left pneumothorax and a right pleural effusion. A chest tube removed 145 mL of serosanguinous fluid.
  • With vigorous diuresis and CPAP oxygen, the patient's respiratory function gradually improved. He left intensive care 10 days after admission and was discharged 1 month after admission.
  • A chest CT scan 20 days after admission showed extensive fibrosis of both lung bases, small bilateral pneumothoraces, multiple pleural-based nodules and extensive lymphadenopathy.
• The authors' conclusion: The author concluded that the cause was obscure, but that the timing of rapid paracentesis through the catheter followed by respiratory distress suggests a causal relationship. The author postulated that rapid intraperitoneal fluid shifts and negative pressure may have been transmitted to the thorax, producing noncardiogenic pulmonary edema and pneumothorax. The author suggested that the catheter bore, needle gauge and unrestricted negative pressure permit very rapid fluid removal and may represent a potential hazard for patients with implanted catheters.
• Limitations the authors state:
  • The author stated that the cause of the respiratory distress is obscure; the causal link rests on timing alone.
  • The author noted that this patient may have been particularly prone to such events because his lungs were stiff, infiltrated and tethered to the chest wall by tumor.

Related studies

• 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)
• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• Implantable access system for prolonged intrapleural immunotherapy — P. Driesen, C. Boutin, et al. (1994)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Catheter tract metastasis associated with indwelling pleural catheters — R. Thomas, C.A. Budgeon, et al. (2014)

Browse more research in Journal of Clinical Oncology, or return to medical research.