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Aug 14, 2021 11:47AM
I'm sorry to hear so many are experiencing pain with draining using the PleurX catheter. I drained the fluid at home, and controlled the velocity by gently pinching the catheter tube to slow it to a more comfortable level. I don't remember draining until completely dry - just when the fluid was nearly gone. When systemic therapy begins to work, draining is no longer needed.
In case it may help, below from my book, "The Insider's Guide to Metastatic Breast cancer" which is also available as a complimentary .pdf, is a list of drainage options. For information about approved treatments by subtype, contending with side effects, cutting edge research and more, please visit https://www.insidersguidembc.com
Pleural effusion, which may accompany lung metastasis, is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. Often the fluid contains cancer cells. Pathology testing should whether the pleural effusion is "exudative" (the fluid has excess protein, blood, or evidence of inflammation or infection) or "transudative" (characterized by a low cell and protein content), based on the chemistry of the fluid. If the fluid transudative it's very unlikely to be malignant, and if it's exudative, malignancy is still a possibility even if malignant cells don't show up when the fluid is tested, so re-testing should be done as warranted, along with any other recommended tests. If the effusion turns out to have malignant cells, testing should be done for ER, PR, and HER2 receptivity, since it is possible that the cancer cells in the effusion may have a different profile than metastasis elsewhere in the body.
For patients who have pleural effusion, there are three methods of draining the fluid to provide relief:
Indwelling (Pleurx or Aspira) Catheter: This is the surgical insertion, under general anesthesia, of a small tube placed temporarily into the pleural space that allows the patient or his/her family member to drain the fluid into a bottle as needed. Patients with an indwelling catheter are fully mobile and are not "attached" to the draining bottle except when draining the fluid. Once there is no more drainage at all, the catheter is removed either in the doctor's office or an outpatient procedure. Overall, indwelling catheters seem to help prevent the fluid from building up again, provided that the patient's systemic treatment is working. The Pleurx catheter works via suction, and the newer gentler model is the Aspira catheter, which is a bit less uncomfortable because uses gravity instead of suction for draining.
Pleurodesis (sometimes referred to as a "talc procedure") is a process in which substances, such as talc, are used to try to get the edge of the lung to stick to the chest wall to decrease the chance of the fluid returning. Although this procedure seems to help prevent the fluid from building up again (provided that systemic treatment is working) it can be painful and usually requires a brief hospital stay. Some patients have reported discomfort months and even years after the procedure. In rare cases, the procedure may fail altogether, rendering it impossible to drain the fluid thereafter because it becomes trapped in a honeycomb of many small pockets (called "loculations"). Of all options for draining malignant pleural effusion, this appears to be the most risk-prone.
Thoracentesis (sometimes referred to as "tapping") is an outpatient procedure that involves placing one needle per required side into the pleural space. Although local anesthesia is administered, this procedure can be uncomfortable and may cause scarring if repeated over time. The procedure also does not hinder fluid buildup again. These tips may make the procedure less uncomfortable: 1) Request a numbing agent before the needle is inserted to feel more comfortable after the procedure. 2) Request that the fluid to be withdrawn slowly in order to avoid low blood pressure or a "fainting" feeling afterwards. 3) Lean forward with a soft pillow supporting your head and upper torso while the draining is underway via your back.
Warning: If a patient is experiencing shortness of breath but the doctor cannot find anything in the lungs that is causing it, the patient should be checked carefully for blood clots as well as for cardiac issues. Either of these issues may cause symptoms that appear to be lung related problems, when in fact they are not. Additionally, a condition called "pneumonitis" (inflammation of the lung), can cause shortness of breath and coughing. Since pneumonitis can be caused by cancer treatments such as chemotherapy and radiation, MBC patients may be particularly susceptible.
10/6/2011, IDC, Left, Stage IV, ER+/PR+, HER2-