Gravity Versus Vacuum Based Indwelling Tunneled Pleural Drainage System

NCT ID: NCT03831386

Last Updated: 2025-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-31

Study Completion Date

2026-12-31

Brief Summary

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Malignant pleural effusion remains a debilitating complication of end stage cancer, which can be greatly improved by the introduction of the indwelling tunneled pleural catheter (IPC). However, there is no standard of care regarding drainage and limited data on the utility of different drainage techniques. In addition, many patients develop discomfort and chest pain during drainage. The investigators propose to evaluate gravity drainage and suction drainage on quality of life measures and outcomes.

Detailed Description

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Indwelling tunneled pleural catheters (IPCs) are used to alleviate pleural effusion as a first-line therapeutic (albeit palliative) intervention. Limited data currently exists on drainage techniques and the impact the techniques may have on quality of life. Current recommendations for IPC drainage range from daily drainage to once a week drainage, as well as only when needed for dyspnea. It has been theorized that active drainage of effusions may have an impact on the development of chest discomfort/pain, whereas passive regimens may allow for more gradual intrathoracic pleural changes and potentially offer a difference in drainage discomfort.

The objective of this investigation is to compare different drainage strategies of indwelling pleural catheters (IPCs) regarding patient quality of life and outcomes. Patients will undergo placement of a pleural catheter as per standard institutional protocol. Patients will be randomized on a 1:1 basis into the suction drainage (active) arm or the gravity drainage (passive) arm. Patients will receive follow-up at two weeks, four weeks, twelve weeks and then as needed post IPC placement per standard clinical protocol. All patients will be asked to fill out quality of life questionnaires and update drainage diary information with patient's providers.

Patients will undergo standard care treatment throughout the disease course and no different interventions regarding the pleural disease will be performed as a result of enrollment within this study. Study interventions/procedures will consist of questionnaires and patient self-reported documentation regarding patient's care and outcomes.

Conditions

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Pleural Effusion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Vacuum

The pleural fluid will be drained by the syringe system with a one-way valve tubing system provided in the kit. Selection of the vacuum pressure will be at the discretion of the proceduralist, as per standard of care. Participants in this arm will undergo Vacuum-Based IPC.

Group Type ACTIVE_COMPARATOR

Vacuum-Based IPC

Intervention Type PROCEDURE

An indwelling pleural catheter is placed inside the chest cavity to drain fluid from around the lungs. One end remains inside the body while the other drains via suction.

Gravity

The pleural fluid will be drained using gravity drainage to a bag positioned at bedside. Participants in this arm will undergo Gravity-Based IPC.

Group Type EXPERIMENTAL

Gravity-Based IPC

Intervention Type PROCEDURE

An indwelling pleural catheter is placed inside the chest cavity to drain fluid from around the lungs. One end remains inside the body while the other drains via gravity.

Interventions

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Vacuum-Based IPC

An indwelling pleural catheter is placed inside the chest cavity to drain fluid from around the lungs. One end remains inside the body while the other drains via suction.

Intervention Type PROCEDURE

Gravity-Based IPC

An indwelling pleural catheter is placed inside the chest cavity to drain fluid from around the lungs. One end remains inside the body while the other drains via gravity.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Clinical indications for placement of IPC for malignant pleural effusion

a. Pleural effusion with symptomatic improvement in dyspnea after drainage of ipsilateral effusion
* Clinically confident symptomatic malignant pleural effusion

1. Histocytological proof of pleural malignancy
2. Recurrent large pleural effusion in context of histologically proven cancer outside the pleural space
* Plans for placement of IPC within ten days of enrollment
* Age \> 17 years
* Sufficient fluid on ultrasound to allow for safe insertion of IPC

Exclusion Criteria

* Recent (less than 60 days) thoracic surgery or chest trauma causing chronic pain
* Pregnant or lactating mothers
* Previous ipsilateral chemical pleurodesis
* Current contralateral indwelling pleural catheter
* Known rib or thoracic skeletal metastasis causing pain
* Concern for active pleural infection
* Respiratory failure
* Irreversible bleeding diathesis
* Inability to provide care for indwelling tunneled pleural catheter
* Significantly loculated pleural space precluding drainage of pleural space, for which IPC alone will likely not offer symptomatic benefit
* Inability to read/understand/write in the English language
* Inability to follow-up for appointments/protocol
* Subject has any clinical condition, diagnosis, or social circumstance that, in the opinion of the investigator would mean participation in the study would be contraindicated.
* Enrollment in alternative pleural catheter trial that would preclude enrollment within this trial
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rocket Medical plc

OTHER

Sponsor Role collaborator

Swedish Medical Center

OTHER

Sponsor Role collaborator

Medical University of South Carolina

OTHER

Sponsor Role collaborator

University of Oxford

OTHER

Sponsor Role collaborator

Vanderbilt University Medical Center

OTHER

Sponsor Role collaborator

Northwest Community Healthcare

UNKNOWN

Sponsor Role collaborator

Johns Hopkins University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lonny Yarmus, DO

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins University

Locations

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Northwest Community Healthcare

Arlington Heights, Illinois, United States

Site Status RECRUITING

Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status RECRUITING

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status RECRUITING

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status RECRUITING

Swedish Medical Center

Seattle, Washington, United States

Site Status RECRUITING

University of Oxford

Oxford, , United Kingdom

Site Status NOT_YET_RECRUITING

Countries

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United States United Kingdom

Central Contacts

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IP Research

Role: CONTACT

410-502-2533

Facility Contacts

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Neeraj Desai, MD

Role: primary

Brittany Adams

Role: backup

Lonny Yarmus

Role: primary

410-502-5224

Gerard Silvestri, MD

Role: primary

843-792-9200

Fabien Maldonado, MD

Role: primary

615-936-8422

Christopher R. Gilbert, MD

Role: primary

206-215-6800

Najib M Rahman, FRCP DPhil

Role: primary

01865 225205

Other Identifiers

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IRB00158671

Identifier Type: -

Identifier Source: org_study_id