Indwelling pleural catheter for the management of empyema in a patient with learning disability: A case of medical complexity

Routine use of IPC in the management of infection of the pleural space is contraindicated although there are challenging situations in which chest drains cannot be used due to number of reasons. A 63-year-old patient with a background of paranoid schizophrenia and severe learning disability with challenging behaviour presented with deterioration of mental health status for 2 days and chest discomfort and was managed as aspiration pneumonia. Her clinical condition deteriorated despite treatment and repeat CXR showed right sided effusion. Effusion was suspected to be pleural empyema and it was treated with chest drains. The patient pulled out three chest drains and it was challenging to retain the drain in situ to manage the empyema. There was concern of a trapped lung and pus was building up as the chest drains could not be maintained. A multi-disciplinary meeting was held, and it was decided to proceed with an Indwelling Pleural Catheter (IPC) with intermittent drainage, as keeping the IPC connected to water seal was not possible.