1. Siân Cleaver1, Dr Nikki Pease2, Hilary Thomas2, Dr Audrey Yong2
Poster number: 16
Audit of the outcomes associated with the insertion of indwelling peritoneal drains in palliative patients at a tertiary referral cancer centre
Siân Cleaver1, Dr Nikki Pease2, Hilary Thomas2, Dr Audrey Yong2
1Cardiff University
2Velindre Cancer Centre, Cardiff
Corresponding author:
OBJECTIVES
This audit aims to investigate the clinical efficacy of indwelling intraperitoneal catheters (IPCs) for paracentesis in cancer patients with recurrent malignant ascites. The audit findings will inform the update of VCC Paracentesis Guidelines, to include specific IPC Guidelines.
RESULTS
A total of 124 procedures in 122 patients (aged years) were documented (79 women, 43 men; ages years). One procedure was not successful.
At the time of writing (April 2017), 12 patients are alive. 110 died (from malignancy). In 91.1% patients there was no documented evidence of removal. Duration of IPC in situ ranged from 0 days to 85 weeks (Figure 1), mean 13.5 weeks and median 7 weeks.
INTRODUCTION
Malignant ascites (MA), which can occur at any stage of cancer, is the accumulation of fluid in the peritoneal cavity caused by the dissemination of malignant cells (carcinomatosis) in cancer patients1.
MA is usually an end-stage illness and a poor prognostic indicator, with the average survival rate 5.7 months following onset of ascites in most cancers2. Treatment options for malignant ascites are limited, and focused primarily on palliation of symptoms and improving quality of life.
There is growing popularity in the use of indwelling intraperitoneal catheters, or IPCs, which allow repeated drainage over weeks-months. The patient (or their care-giver) is able to drain their IPC at home, avoiding further hospital visits.
Despite a multitude of studies assessing efficacy of the PleurX® IPC in particular, there are currently no validated guidelines on the use of IPC3. There is also little long-term survival data.
Figure 2. Complications caused by IPC insertion
Complications
38 (25%) patients experienced IPC-related complications. Infection was the most common type of complication, followed by problems with drainage and fluid loculation (Figure 2). Of the patients with complications with their IPC, in 79.5% cases, correct management was documented. 7.4% of patients were admitted to hospital due to complications with their IPC.
8.4% patients had a low platelet count (<150x109/l) at IPC insertion, with 30% of these patients going on to develop infection.
METHODS
The database collected by the healthcare professionals at VCC who placed the IPC indicated 122 patients with MA underwent IPC insertion at VCC between May 2012 to February 2017.
Further necessary patient information for the following criteria was accessed via the Velindre patient electronic database: patient information, patient status, IPC status, complications, protocol adherence.
Equipment costs for both paracentesis and IPC insertion were also calculated.
Cost analysis
Table 1 displays the calculated equipment costs for both paracentesis and IPC procedures. Additional associated costs (hospital bed, staffing, patient transport, etc) were not calculated.
Figure 1. Total length of time IPC in situ, until documented removal or patient death.
Table 1 Total cost of equipment for paracentesis and IPC insertion
Procedure 
Cost 
Paracentesis
£46.57
Indwelling peritoneal catheter (Rocket®)
£246.45
CONCLUSION
This audit has found that use of the Rocket® indwelling peritoneal catheter device to be a safe treatment for recurrent malignant ascites, in line with current literature. The total equipment cost of IPC is five times that of paracentesis, however it is likely savings are made in terms of reducing hospital admissions and clinician time.
References:
Adam, R.A., Adam, Y.G Malignant ascites: Past, present, and future. J Am Coll Surg; 198:999–1011.
Mercadante, S., Intravaia, G., Ferrera, P., et al Peritoneal catheter for continuous drainage of ascites in advanced cancer patients. Supportive Care Cancer; 16:975–8.
Cavazzoni, E., Bugiantella, W., Graziosi, L., et al Malignant ascites: pathophysiology and treatment. Int J Clin Oncol; 18:1–9.