Your doctor has recommended a procedure called pleurodesis to try and help control the build-up of fluid and/or air around your lung. This leaflet has been written to help you understand what pleurodesis via a chest drain means, what it involves and what you can expect after the procedure.
What is a chest drain?
A chest drain is a small flexible tube that is inserted into the lungs to drain fluid or air. There is a separate leaflet about this that your doctor can provide you with to understand more detail about the procedure.
What is Pleurodesis?
This procedure involves trying to stick your lung to the inside of your ribcage in order to prevent further build-up of fluid or air.
The procedure usually involves the introduction of a mildly irritating substance (usually sterile medical talc) into the space by putting it down the chest drain. You may already have the chest drain in place. This sticky substance seals up the space and prevents the fluid or air from returning. This can provide a permanent solution in people who have repeated or ongoing problems.
Why do you need Pleurodesis?
The pleural space is the gap between two thin layers, one lining the lung and the other lining the chest wall. These layers normally lie very close together and are usually lubricated by a small amount of fluid. In your case fluid or air has collected in this space so that the lung cannot function properly, making you short of breath.
In people who have fluid build-up (pleural effusion), it can reoccur after chest drain removal causing ongoing breathlessness and often requiring further drainage. Pleurodesis offers a permeant solution.
What are the alternatives?
There are several alternatives to pleurodesis which can be discussed with you by your doctor.
They include:
- Managing your breathlessness by use of drugs such as oxygen and morphine
- A permeant drain system (Indwelling pleural Catheter – IPC, separate leaflet available)
- Repeated removal of pleural fluid
While repeated procedures are possible they are uncomfortable, carry risk each time the procedure is carried out and require repeated trips to hospital.
What does the treatment involve?
The process requires an admission to hospital. The time required varies from patient to patient but is generally between four and seven days.
The procedure will take place on the respiratory ward (ward 9). You will meet with the doctor and nurse before the procedure and have an opportunity to ask any questions and go through the consent form.
The first step is the insertion of a chest drain. This is a small flexible tube that allows drainage of fluid and/or air from the space around the lung. You will then be asked to lie or sit in a comfortable position. If you have a fluid build-up an ultrasound scan of your chest is done first to decide on the best position for the drain. This is completely painless.
Your skin will be thoroughly cleaned with an antiseptic to minimise the risk of infection. Local anaesthetic is then injected into the skin to numb or freeze the place where the tube will go. This can sting a little but should go away quickly. The tube can then be inserted and stitched into place. A dressing is put over the skin to keep the area clean and the tube is attached to a drainage bottle to collect the fluid or allow the air to escape.
After this we need to allow as much fluid to drain as possible. This can take several days, and you will likely need several x-rays during this time.
When your doctor is happy that the fluid has resolved we can perform the pleurodesis procedure. This involves inserting local anaesthetic (numbing or freezing medication) into the chest space via the tube. The medication (usually sterile medical talc in liquid form) is then inserted, and the ‘tap’ closed on the drain to keep the medication inside. After an hour the tap is opened again to allow the medication and any further fluid out. The drain usually stays in place for a further one to two days to allow all remaining fluid to drain and give the procedure the best chance of working.
Will it be painful?
When your doctor inserts the chest drain they will use local anaesthetic to prevent you feeling pain while the drain goes in. You may feel a ‘pushing’ or ‘tugging’ sensation, but it should not be painful. At the end of the procedure your chest may feel bruised or sore for a few days, but this can be controlled with pain relief.
We therefore routinely give relief to all patients having the procedure. Inserting the pleurodesis medication is usually completely painless and you may not even notice, or you may feel the cold fluid in your chest. This medication works by irritating the two linings to cause them to stick together. This irritation can cause a sharp pain often referred to as ‘pleurisy’. The amount of discomfort, however, widely varies from person to person. If you encounter pain or discomfort we can give you pain relief. If you experience any pain that isn’t controlled, please tell your nurse so that further pain relief can be provided.
How long does it take?
Each part of the procedure takes 20-40 minutes.
How successful is pleurodesis?
The procedure stops the fluid or air from returning in around seven out of ten (70%) patients. If it does come back you may need to have further drainage, or we can consider one of the alternative options described above. Rarely, some people will be offered a second attempt at the procedure, but this has a lower success rate.
This success rate depends on all the fluid or air being drained from the chest and the lung re-inflating normally. In some people this does not happen, and we say that the lung is ‘trapped’. This is usually evident in the first few days and will prevent us from being able to undertake the procedure. If this happens then the drain will be removed and again the alternatives listed above can be discussed.
Is there anything I need to do to look after the drain?
Whilst the drain is inserted you will need to take extra care to not dislodge the tube. You can walk around the ward, but you will need to take the drainage bottle with you. This must always be kept below the waist to prevent fluid draining the wrong way into your chest. We do not recommend leaving the ward with a drain when you go for x-rays or other tests away from the ward a member of staff will accompany you to help care for the drain.
If the drain becomes detached, you accidently knock over the bottle or you are worried you may have pulled on the drain, please inform a nurse straight away.
What are the risks?
In most cases, the insertion of a chest drains and pleurodesis is a routine and safe procedure. However, like all medical procedures, there are risks:
- Any tubes that are inserted into the skin carry a small infection risk, around 1 in 100. These risks increase the longer the tube stays in place. This complication can usually be treated with antibiotics but may require a longer stay in hospital.
- Sometimes the drains can become displaced or blocked and prevent the procedure from being completed.
- Very rarely, the insertion of the drain may cause accidental damage to a blood vessel or other organ and cause serious bleeding. This only affects around 1 in 500 patients. Unfortunately, if it does happen it is a serious problem which may require an operation to stop it.
- As discussed above some people can experience pain or discomfort. This is usually controlled with pain relief.
- Sometimes people can develop a temperature after the procedure. This can be usually controlled with paracetamol.
- Rarely the irritation of the lung can cause breathlessness itself. This usually settles after a few days and can be treated with oxygen. Very rarely this can be fatal, around 1 in 1000 cases.
- Sometimes cancer tissue can affect the area where the drain was inserted. Please let your doctors know if you develop a lump, or any pain at the site. If this problem does develop your doctor will advise you on appropriate treatment.
What if I take blood thinning tablets/injections?
If you take Clopidogrel/Plavix, aspirin, warfarin or one of the new blood thinning tablets such as rivaroxaban or apixaban please tell your doctor who will discuss a personalised plan for these prior to the procedure.
Can I wash and shower normally?
Initially after insertion there will be a dressing placed on the catheter and we advise you to keep this dry. You can usually wash with assistance in the shower, but it may be easier to have a wash with a bowl of water at the bedside for a few days. The nurses on the ward can assist and advise you on an individual basis.