Pleurodesis: Attaching the lung to the chest wall to control fluid or air in the space around the lung

What is pleurodesis?

Pleurodesis is a procedure that involves placing a mildly irritating mineral powder into the space between the lung and the chest wall (pleural space). It is done to try to ‘stick’ the lung to the chest wall and to prevent the re-accumulation of fluid or air collected in this space. The mineral powder is inserted into the chest through a chest tube that is already in situ. Pleurodesis can be performed as an inpatient during hospital admission or as an outpatient in an ambulatory clinic setting

How does pleurodesis work?

The mineral powder that is put into your pleural space will irritate the lining of the lung and the chest wall. This causes the surfaces to become sticky and bond, sealing up the space between them and preventing fluid or air from collecting there.

Why do I need pleurodesis?

The doctor has suggested pleurodesis because you have a collection of fluid or air in your pleural space, and we believe it is likely to recur in the future if nothing is done to seal the area where it has collected. Pleurodesis will prevent this from happening.

Do I have to have it done?

No, but your doctors believe this is the best way of stopping the problem in your chest coming back. However, it is your choice whether to go ahead with this treatment.

What does the treatment involve?

The pleurodesis will be done through the tube (chest drain) that has already been put into your chest to drain away the fluid or air collected in your pleural space. Once your chest drain has drained completely, the pleurodesis drug (which is usually sterile talc) will be put into your chest through this drain. The mineral powder is usually injected in a liquid form.

Sometimes pleurodesis can cause some pain. We will give you some painkillers before the procedure to help with this. However, it is still common to feel discomfort during the procedure. If this happens,

Please notify the nurse or doctor so we can provide you with additional pain medication.

After the pleurodesis, a mineral powder has been placed in your chest. Your drain may be closed for approximately one to two hours. The drain will then be reopened to allow drainage of any fluid or air to begin again. The chest drain is usually left in position for 24 to 72 hours, but it may be left in place longer if fluid or air drainage continues. Whether this was performed as an inpatient or outpatient, you will either need to stay in the hospital until the drainage is reduced (inpatient) or require regular community chest drain review until the doctor considers the drainage tube no longer needed. Once the drain is removed, the procedure is complete. A single stitch is sometimes required to close the site where the chest drain was inserted. If so, it will be removed after seven to fourteen days.

How successful is pleurodesis?

Pleurodesis prevents the recurrence of fluid or air collection in about 7 to 8 out of 10 cases (70-80%). If it returns, further drainage may be necessary. In some cases, another attempt at pleurodesis can be made. If a second pleurodesis is needed, the success rate is often lower.

What are the expected benefits?

When fluid or air accumulates in the pleural space, it usually causes breathlessness. Pleurodesis prevents fluid or air from accumulating, which should improve breathing.

What are the risks or complications?

• Most patients undergo pleurodesis without any significant problems. However, like all medical treatments, it does have some risks:
• Sometimes patients experience chest pain from pleurodesis. Painkillers are given as needed to help relieve this.
• Some patients experience fever for the first day or two after the procedure. This is usually controlled with paracetamol and is short-lived.

Sometimes, pleurodesis can cause breathlessness due to excessive inflammation in the lung. This usually resolves over a few days with oxygen treatment, although it is very rare (about 1 in 1,000) and can be serious. All treatments that require a tube in the chest carry some risk of causing infection. This happens in about 1 in 50 (2%) of patients. It usually resolves with antibiotic treatment, although it may require a more extended hospital stay or admission.

What are the alternatives?

For patients with collections of fluid, the following options are available:

• The fluid can be drained out of the chest, and then the chest drain is removed, and the patient is sent home. This treatment has the advantage that the patient can go home and does not require a chest drain. Still, its significant disadvantage is that the fluid is likely to recur (in almost 100% of cases), necessitating further treatment.
• Or an indwelling pleural catheter placement, where a small flexible tube is placed in the chest, with which the patient goes home, and either the community nurses drain at home or the patient learns how to drain themselves.

How to contact / further information

If you would like any further information about this procedure please contact the interventional pulmonology/ pleural service on 01223-349189.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.