NCT03325192

Rapid Pleurodesis Through an Indwelling Pleural Catheter

A Randomized, Double Blinded, Controlled Trial of a Rapid Pleurodesis Protocol After Indwelling Pleural Catheter Placement for Malignant Pleural Effusions

• Status: Terminated
• Phase: N/A
• Study type: Interventional
• Enrollment: 11 (actual)
• Sponsor: University of Pennsylvania · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The primary objective of the study is to evaluate whether the use of a rapid pleurodesis protocol using 10% iodopovidone immediately after tunneled pleural catheter placement improves time to IPC removal compared to patients who receive an IPC alone.

Detailed description

Patients will be screened throughout the year as part of the clinical referral process to the Interventional Pulmonology service at the Hospital of the University of Pennsylvania for the management of a malignant pleural effusion. Patients eligible for inclusion based on the clinical evaluation will be approached for enrollment. Written consent will be obtained. Patients will subsequently undergo placement of a IPC under MAC as per standard clinical practice followed by complete drainage of the pleural space. Patients randomized to the rapid pleurodesis protocol arm will received 20mL of 10% iodopovidone mixed with 80mL of normal saline instilled intrapleurally through the IPC. Patients randomized to the standard of care arm will have 100mL of normal saline (placebo) instilled intrapleurally through the IPC. The mixture will be allowed to dwell for 2 hours and then completely evacuated through the IPC and the patient will be discharged home. After discharge, all patients will continue to drain their IPC on a daily basis for 7 days. Following this, all patients will continue to drain their IPC on an every-other-day basis until total IPC output is less than 50ml per session over 3 consecutive sessions. At which point they will be asked to undergo a clamp trial of no drainage for 7 days followed by a reattempt at drainage. Patients without return of symptoms over those 7 days and minimal drainage afterwards (\<50ml) will be seen in the office for possible IPC removal. Patients with return of symptoms during those 7 days or more than minimal drainage afterwards (\>50mL) will be asked to continue drainage until total IPC output is again less than 50mL per session over 3 sessions. After a passed clamp trial, patients will be evaluated in the office with a bedside ultrasound to assess for pleural apposition in 5 of 6 designated points and the absence of pleural effusions. If all criteria are met, the IPC is removed. If there is evidence of residual effusion, continued drainage will be advised. All patients will be evaluated in the office on day 7, day 14, day 30, day 60 and day 90 after IPC placement. On each visit they will be assessed for pleural apposition with ultrasound. At day 30, 60, and 90 all patients will receive a global health related questionnaire (EORTC QLQ30) and a symptom questionnaire. At 90 days, complications rate will be assessed for the entire study period.

Conditions

• Pleural Effusion, Malignant
• Pleurodesis
• Pleural Diseases

Interventions

Type	Name	Description
DRUG	Rapid pleurodesis protocol	* The pleural space will be evacuated completely through the newly placed IPC * 20mL of 10% iodopovidone and 80mL of normal saline will be instilled into the pleural space * The patient will be transferred to the recovery unit * Two hours after instillation the pleural space will be drained * After recovery from anesthesia and complete drainage of the pleurodesis mix, the subject will be discharged * Subjects will be asked to drain their effusion on a daily basis for the next 7 days and then on an every other day basis.
OTHER	Placebo	* The pleural space will be evacuated completely through the newly placed IPC * Only placebo (normal saline) will be instilled into the pleural space * The patient will be transferred to the recovery unit * Two hours after instillation the pleural space will be drained * After recovery from anesthesia and complete drainage of the pleurodesis mix, the subject will be discharged * Subjects will be asked to drain their effusion on a daily basis for the next 7 days and then on an every other day basis.

Timeline

• Start date: 2017-12-12
• Primary completion: 2019-07-09
• Completion: 2019-07-09
• First posted: 2017-10-30
• Last updated: 2020-05-08

Locations

1 site across 1 country: United States