CHEST Guidelines-Repair-of-Tunneled-Pleural-Catheter

Repair-of-Tunneled-Pleural-Catheter_chest

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The document contains two letters to the editor from the journal 'Chest.' The first letter discusses the current state and implications of sepsis management. While recent studies show that usual care is noninferior to Early Goal-Directed Therapy (EGDT), it argues this is due to improvements in usual care rather than EGDT's ineffectiveness. These improvements include prompt administration of antibiotics and IV fluids. However, the authors caution against unnecessary antibiotic use in non-septic patients, as this could lead to poorer outcomes. They emphasize the importance of antibiotic stewardship and that the improved sepsis care underscores the foundational principles of EGDT—early antibiotics and fluid resuscitation—as cornerstones of sepsis management.<br /><br />The second letter focuses on the repair of a tunneled pleural catheter used for managing pleural effusions. The authors describe a procedure for replacing the endpiece of a malfunctioned PleurX catheter on a patient with metastatic renal cell carcinoma. The patient had experienced a breakdown in the catheter's securement tab and one-way valve, leading to a need for a creative repair using components from a new PleurX catheter kit. The repair was executed by using cyanoacrylate and cable ties to securely attach a new one-way valve to the existing catheter tubing, restoring its function. The authors highlight such repairs' efficacy, which allowed the patient to achieve pleurodesis and remove the catheter. This case also encourages the manufacturer to consider producing a repair kit based on their approach.<br /><br />Both letters emphasize the importance of evolving medical practices and offer insights into clinical management, whether in sepsis or pleural effusion scenarios.

Keywords

sepsis management

Early Goal-Directed Therapy

antibiotic stewardship

fluid resuscitation

pleural effusion

PleurX catheter

catheter repair

cyanoacrylate

clinical management

medical practices