2 The technology

Description of the technology

2.1 The PleurX peritoneal catheter drainage system (BD) is intended for use in the management of treatment-resistant, recurrent malignant ascites (accumulation of fluid in the peritoneal cavity) in the community setting [2018].

2.2 The PleurX peritoneal catheter is made of silicone and is 71 cm in length and 5.12 mm (15.5 Fr) in diameter. The distal end of the catheter has several side holes and is placed in the peritoneal cavity. There is a polyester cuff midway along the catheter, which is sited 1–2 cm within a subcutaneous tunnel and helps to secure the catheter in place by encouraging tissue growth into the polyester. The external end of the PleurX peritoneal catheter has a safety valve that prevents air entering or fluid leaking out of the catheter. A cap protects the valve and prevents debris from building up.

2.3 The drainage system comprises a 1-litre vacuum bottle with a drainage line that connects to the PleurX peritoneal catheter for fluid removal. It also includes a procedure pack that contains the supplies needed to perform the drainage procedure and to replace the cap and the gauze pad dressing over the catheter.

2.4 The PleurX peritoneal catheter is designed to remain in place indefinitely and patients and carers are trained to perform fluid drainage when needed by attaching the vacuum bottle to the catheter. A fresh valve cap and dressing are applied once the drainage is completed. For the majority of the time, the catheter is coiled up and covered with a gauze pad and a waterproof dressing.

2.5 The list prices stated in the sponsor's submission for the PleurX peritoneal catheter and the PleurX drainage kit with a 1-litre vacuum bottle are £245 and £64 per unit respectively.

2.6 The claimed benefits of the PleurX peritoneal catheter drainage system in the case for adoption presented by the sponsor are:

  • Repeated drainage of ascitic fluid in community settings may allow greater patient independence, and the flexibility to fit the drainage procedure into their daily lives.

  • Better symptom control by frequent drainage of smaller quantities of ascitic fluid. Symptoms associated with the accumulation of large amounts of ascites include breathlessness, nausea, bloating, acid reflux, abdominal pain, early satiety, reduced mobility and psychological distress related to negative body image.

  • Reduced need for repeated large-volume paracentesis procedures and the associated risk of infection from repeated catheter insertion.

  • Resource savings through a reduced need for hospital physician and nurse time, outpatient visits and hospital bed days.

Current management

2.7 The conventional management of treatment-resistant, recurrent malignant ascites involves repeated large-volume paracentesis (needle drainage of fluid) procedures that are carried out in hospital. Most commonly this is done as an inpatient procedure, although some centres are able to offer paracentesis as a day case procedure. Inpatient paracentesis is carried out when patients have developed troublesome symptoms from recurrent ascites. This can entail some delay while waiting for admission, during which the patient continues to experience symptoms.

2.8 Paracentesis involves inserting a catheter, often under local anaesthetic, into the peritoneal cavity to drain ascitic fluid. During large-volume paracentesis the catheter stays in place until most of the ascites has been drained, which often exceeds 5 litres of fluid. This may be done in one go, but some patients cannot tolerate rapid drainage and may need to stay in hospital for one or more nights for repeated drainage procedures.

  • National Institute for Health and Care Excellence (NICE)