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Tunneled pleural catheters (TPCs) have become a popular therapeutic tool for chronic pleural effusions. Although the main indication for a TPC has been recurrent, symptomatic, malignant pleural effusion, there are increasing reports of TPC usage in other medical conditions. This article will address the utility of TPCs in malignant pleural effusions, other reported uses, potential complications and catheter maintenance.The efficacy of TPCs has been well established in the setting of malignant pleural effusions and this option is now included in the guidelines addressing treatment of this condition. TPCs appear to have similar cost-effectiveness compared to chemical pleurodesis and are particularly useful in patients with trapped lung syndrome or who have shorter predicted lifespans. Attempts at bridging the benefits of pleurodesis and TPCs have been described by several groups and the recent reports have considered their use in chronic benign conditions including congestive heart failure, hepatic hydrothorax and chronic pleural infections.TPCs are an effective management strategy for symptomatic, recurrent, malignant pleural effusions. Their use as a first-line treatment is feasible and TPCs are particularly preferred for patients with trapped lung or those who are not considered good candidates for chemical pleurodesis because of short life-expectancy. There currently lacks sufficient evidence to recommend the use of TPCs in nonmalignant pleural diseases.