The efficacy of Jackson drain in the application to be a tunnel pleural catheter (TPC) in the management of malignant pleural effusion

Abstract

Background: Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer and portends a poor prognosis, which means survival of less than six months. In June 1997, the US-FDA approved an indwelling TPC with a one-way drainage valve to be used in the management of MPE. Although popularity of this TPC has increased over the past few years, the experience with this device remains limited in Thai patients. One of the reasons is its high cost. Objective: Assess the efficacy and the safety of customary indwelling TPC by using Jackson drain in the management of patients with symptomatic MPE. Material and Method: Ten patients with symptomatic MPE were receiving these catheters (18 Fr Silicone catheters with 25cm fenestrated length) to drain effusion via plastic vacuum bottles (250ml) every other day or as needed to relieve dyspnea. The patient's dyspnic respiration, quality of life, and comfort during the catheter's application were quantified with a Borg score, the St. George Respiratory Disease Questionnaire (SGRQ), and the comfort's score, respectively. These parameters were recorded at initial (before insertion) and 2-week follow-up visit. Pain after 24 hours of each insertion was quantified by visual pain analogue scale (VPAS). Patients were followed until either death or catheter removal. Results: The Borg score, SGRQ, and comfort's score showed significant improvement at 2-week visit (p < 0.05). Mean VPAS was 2.44. There was no early (2-week) complication, but the catheters were obstructed in three patients (mean = 60 days) and slipped out in two (day18, day 50). Conclusion: This modified Jackson drain was effective in the treatment of MPE as a TPC without early complications.