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P197 Incision-free removal of indwelling pleural catheters

Introduction Indwelling pleural catheters are now frequently used in the management of recurrent pleural effusions. Pleural drainage eventually ceases in the majority of these patients particularly when combined with pleurodesis, prompting catheter removal. This can sometimes prove technically challenging and has traditionally been carried out via a skin incision. There is a lack of data on the optimal method of IPC removal. Aim To assess the efficacy of incision free removal of indwelling pleural catheters Method At our institution the procedure is undertaken in an outpatient setting without a skin incision. All patients are assessed for suitability of IPC removal by reviewing their drainage records and with pleural ultrasonography. If there is no prospect of further pleural drainage and no evidence of catheter blockage, the patient is accepted for the procedure. Local anaesthesia (1% Lidocaine) is infiltrated into the adjacent tissue (figure 1). Firm traction is applied on the catheter and the cuff is freed by blunt dissection using the kilner needle holder (Instrapac Standard Suture Pack) inserted into the tunnel via the catheter entry site. The catheter is then with withdrawn with gentle traction and the wound is closed with a single suture. Between October 2017 and June 2018, all patients requiring IPC removal underwent the procedure using this incision-free approach. The procedure was successful in 22 out of 23 patients. In one case the cuff had migrated into the pleural cavity and could not be dissected free. This IPC was trimmed at the chest wall after applying firm traction at the entry site. No incision was made. The wound was closed and the remaining IPC was retained in the pleural cavity. The IPC has only been in for 6 weeks before attempted removal. Conclusion We have demonstrated IPC removal can be successfully undertaken without a skin incision. This minimally invasive method appears relatively simple and time efficient. It is likely to be preferred by patients as it results in less pain and scarring, however further study is required to confirm this. Figure. No caption available.