Peritoneal and pleural ports for management of refractory ascites and pleural effusions: Assessment of impact on patient quality of life and hospice/home nursing care

Wayne L. Monsky, Ken Y Yoneda, John MacMillan Jr, Larry Stuart Deutsch, Paul R Dong, Helen Hourigan, Yvonne Schwartz, Stacey Magee, Curtis Duffield, Tammy Boak, James Cernilia

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose: Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care. Materials and methods: Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart review and interviews were held with patients and nursing care providers. Mean follow-up was 59 days. Results: On a 10-point scale, QOL improvement, compared to that prior to port placement, was rated a mean of 9.5 by patients and 9.0 by the nursing staff. Both patients and nurses reported a high degree of convenience (rated at 9.7 and 9.6, respectively) and improvement of symptoms and comfort (9.6 and 9.3, respectively). Nursing staff reported a high degree of comfort (9.9) using the aspiration ports. Six of 14 pleural ports were removed following pleurodesis. One pleural port was removed due to patient discomfort and another due to pneumothorax. Two patients with pleural ports developed tumor seeding in the subcutaneous tissues. Of 14 peritoneal ports, 3 required removal for leaking and probable chemical cellulitis. Four became temporarily occluded with patency restored using tissue plasminogen activator (TPA) infusion. Conclusions: Peritoneal and pleural ports offer a convenient and relatively safe alternative to frequent paracenteses/thoracenteses in the management of refractory ascites and pleural effusions. This approach can improve the QOL for patients with end-stage disease.

Original languageEnglish (US)
Pages (from-to)811-817
Number of pages7
JournalJournal of Palliative Medicine
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2009

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Hospice and Palliative Care Nursing
Home Nursing
Pleural Effusion
Home Care Services
Nursing Care
Ascites
Quality of Life
Paracentesis
Nursing Staff
Pleurodesis
Hospice Care
Vascular Access Devices
Cellulitis
Subcutaneous Tissue
Tissue Plasminogen Activator
Pneumothorax
Quality Improvement
Neoplasms
Patient Care
Nurses

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Peritoneal and pleural ports for management of refractory ascites and pleural effusions : Assessment of impact on patient quality of life and hospice/home nursing care. / Monsky, Wayne L.; Yoneda, Ken Y; MacMillan Jr, John; Deutsch, Larry Stuart; Dong, Paul R; Hourigan, Helen; Schwartz, Yvonne; Magee, Stacey; Duffield, Curtis; Boak, Tammy; Cernilia, James.

In: Journal of Palliative Medicine, Vol. 12, No. 9, 01.09.2009, p. 811-817.

Research output: Contribution to journalArticle

Monsky, Wayne L. ; Yoneda, Ken Y ; MacMillan Jr, John ; Deutsch, Larry Stuart ; Dong, Paul R ; Hourigan, Helen ; Schwartz, Yvonne ; Magee, Stacey ; Duffield, Curtis ; Boak, Tammy ; Cernilia, James. / Peritoneal and pleural ports for management of refractory ascites and pleural effusions : Assessment of impact on patient quality of life and hospice/home nursing care. In: Journal of Palliative Medicine. 2009 ; Vol. 12, No. 9. pp. 811-817.
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AU - Deutsch, Larry Stuart

AU - Dong, Paul R

AU - Hourigan, Helen

AU - Schwartz, Yvonne

AU - Magee, Stacey

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AB - Purpose: Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care. Materials and methods: Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart review and interviews were held with patients and nursing care providers. Mean follow-up was 59 days. Results: On a 10-point scale, QOL improvement, compared to that prior to port placement, was rated a mean of 9.5 by patients and 9.0 by the nursing staff. Both patients and nurses reported a high degree of convenience (rated at 9.7 and 9.6, respectively) and improvement of symptoms and comfort (9.6 and 9.3, respectively). Nursing staff reported a high degree of comfort (9.9) using the aspiration ports. Six of 14 pleural ports were removed following pleurodesis. One pleural port was removed due to patient discomfort and another due to pneumothorax. Two patients with pleural ports developed tumor seeding in the subcutaneous tissues. Of 14 peritoneal ports, 3 required removal for leaking and probable chemical cellulitis. Four became temporarily occluded with patency restored using tissue plasminogen activator (TPA) infusion. Conclusions: Peritoneal and pleural ports offer a convenient and relatively safe alternative to frequent paracenteses/thoracenteses in the management of refractory ascites and pleural effusions. This approach can improve the QOL for patients with end-stage disease.

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