Gravity Versus Vacuum Based Indwelling Tunneled Pleural Drainage System

Inclusion Criteria: * Clinical indications for placement of IPC for malignant pleural effusion a. Pleural effusion with symptomatic improvement in dyspnea after drainage of ipsilateral effusion * Clinically confident symptomatic malignant pleural effusion 1. Histocytological proof of pleural malignancy 2. Recurrent large pleural effusion in context of histologically proven cancer outside the pleural space * Plans for placement of IPC within ten days of enrollment * Age \> 17 years * Sufficient fluid on ultrasound to allow for safe insertion of IPC Exclusion Criteria: * Recent (less than 60 days) thoracic surgery or chest trauma causing chronic pain * Pregnant or lactating mothers * Previous ipsilateral chemical pleurodesis * Current contralateral indwelling pleural catheter * Known rib or thoracic skeletal metastasis causing pain * Concern for active pleural infection * Respiratory failure * Irreversible bleeding diathesis * Inability to provide care for indwelling tunneled pleural catheter * Significantly loculated pleural space precluding drainage of pleural space, for which IPC alone will likely not offer symptomatic benefit * Estimated life expectancy of \< 30 days (however, active enrollment in hospice program is not an exclusion criteria) * Inability to read/understand/write in the English language * Inability to follow-up for appointments/protocol * Subject has any clinical condition, diagnosis, or social circumstance that, in the opinion of the investigator would mean participation in the study would be contraindicated. * Enrollment in alternative pleural catheter trial that would preclude enrollment within this trial