Ep. 676 Use of Tunneled Catheters for Ascites & Effusions Management with Dr. Marco Ertreo

When is it time to move from repeat drainage to a tunneled catheter for managing pleural effusions or ascites? On this episode of BackTable Podcast, Dr. Neil Jain interviews Dr. Marco Ertreo, interventional radiologist and IR residency program director at Strong Memorial Hospital, University of Rochester, about best practices for tunneled catheter management in both the chest and abdomen. They discuss the triggers for placing a tunneled catheter, patient selection, placement technique, home drainage protocols, complication management, and the unique considerations for malignant versus cirrhotic ascites. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction06:39 - Indications and Pleural Catheter Placement Technique12:10 - Tunneling, Cuff Position and Exit Site Selection17:42 - Home Drainage, Volume Limits and Complications26:13 - Peritoneal Catheters, TIPS Candidacy and Catheter Choice35:16 - Avoiding Bowel and Varices43:42 - Key Takeaways and Closing Remarks --- More about this episode Dr. Ertreo shares practical details about pocket selection, access points, catheter testing, and choosing Tenckhoff catheters for abdominal cases to avoid proprietary systems. The conversation covers volume limits, complication counseling, criteria for removal, and the psychological impact of living with a long-term drain. They discuss when to consider TIPS for cirrhotic patients, the importance of early conversations with patients and referring providers, and why multidisciplinary teamwork and family support are essential for long-term success. --- Resources Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trialhttps://pubmed.ncbi.nlm.nih.gov/30037711/ Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guidelinehttps://www.atsjournals.org/doi/10.1164/rccm.201807-1415ST Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions, Part II: Recommendationshttps://pubmed.ncbi.nlm.nih.gov/31229333/ Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases (AASLD)https://pubmed.ncbi.nlm.nih.gov/33942342/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app