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---More about this episodeDr. 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.---ResourcesAggressive 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.201807-1415STSociety 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