Tunneled pleural catheter in pleural effusion: To Whom? When? How?

Tunneled pleural catheter (TPC) is a standard option for the management of recurrent pleural effusion (PE), both malignant and nonmalignant. Its ease of implantation, simple home management, and safety profile make it attractive for symptomatic patients requiring relief and improved quality of life. In patients with trapped lung, TPC is the best option for symptomatic relief. In cases of expandable lung, TPC is used to relieve symptoms and, in some cases, to achieve a desirable pleurodesis. In addition to TPC, there are other treatment alternatives in symptomatic PE that should be evaluated, and the final treatment decision should be individualized in each case, considering the patient’s preferences. We present the evidence on TPC in malignant and nonmalignant PE and outline the indications of the catheter according to the etiology of the effusion, discuss the most appropriate time for its implantation, and describe step by step how to do it.