First-line instead of last option

When is a tunneled pleural catheter the first choice?

Malignant pleural effusion, an unclear prognosis, patients who have undergone multiple punctures — and then, at some point, the decision to implant a catheter. This scenario is part of everyday life in many hospitals. Yet care could often be planned in a much more predictable way.

In this interview, Dr. Daniel Baum, thoracic surgeon at the Coswig Lung Center, explains why the tunneled pleural catheter is, in certain situations, the logical first-line decision for him — and how the care team benefits from it.

Dr. Baum, when is a tunneled pleural catheter an option for you as an initial measure?

Dr. Daniel Baum:
We don’t actively use the term “first-line therapy” internally, but yes — there are situations where we know immediately at the very first patient contact that: this will be a chronic, recurrent effusion. For example, in cases of pleural carcinomatosis or cardiac-related effusions.

If a trapped lung is identified intraoperatively, or if obvious pleural carcinomatosis is found during diagnostic thoracoscopy, and long-term drainage therapy is foreseeable, we implant the indwelling catheter directly in order to spare the patient an additional intervention.

How do you proceed specifically if the diagnosis is made intraoperatively?

Dr. Daniel Baum:
If we see during thoracoscopy that the lung is trapped or that the effusion will recur, we implant an indwelling pleural catheter immediately. The goal is to spare the patient an additional procedure.

What is your experience with the procedure itself?

Dr. Daniel Baum:
Implantation is a short procedure and usually involves only a very brief inpatient stay. Postoperative pain is generally minimal. Other approaches are significantly more complex and place a greater burden on the patient.

Which complications do you see more often: with punctures or with the catheter?

Dr. Daniel Baum:
Infections do occur, but that is not a major issue. With repeated punctures, we see more complications, such as bleeding or lung injuries. In many cases, the catheter is the safer option.

How does patient care work after discharge?

Dr. Daniel Baum:
Very well. If discharge, management is organized properly, aftercare also runs smoothly. We also have several ewimed training staff employed here as qualified nursing professionals.

What would you recommend to colleagues from other disciplines?

Dr. Daniel Baum:
Punctures are burdensome, involve risks, and are logistically demanding. If it is clear that the effusion is malignant or cardiac-related with a risk of recurrence, catheter implantation should be seriously considered as an initial measure.

Conclusion

First-line means sparing patients unnecessary interventions, using resources efficiently, and choosing a clear therapeutic pathway at an early stage.

“In most cases, we opt for a drainage solution — temporary or long-term, depending on the situation.”

Take the opportunity to make a first-line decision: recommend, refer, or implant — depending on specialty and clinical context.

Would you like to structure care pathways in your clinic or receive individual consultation? Our team will be happy to support you personally.

More about evidence-based first-line therapy