Pleural Effusion Treatment

Muldoonmom · 07-18-2006, 05:04 AM

Has anyone ever had the chest tube treatment (with antibiotic) to stop pleural effusion? I have had two taps so far and will probably need a third tap next week. After that, if the fluid doesn't stop building up, my onc wants me to have the tube inserted. UGH!
I have mets to the right pleural lining which is causing the fluid. If anyone has experience, please let me know what to expect.
Thank you!
Debbie

madubois63 · 07-18-2006, 05:29 AM

Yes dear - did that. Since you've already been tapped, you already know the kind of pain you will be dealing with - not so horrible. They stick the tube in, pull the fluid out, spray a talc and then leave the tube in for a few days. The worst part for me was when they pulled the tube out. Take an Atavan and a pain killer about a half hour prior. Some people don't experience pain and some do - I did. Best to be prepared. My breathing became increasingly better with each day thereafter. I painted my daughter's bedroom (by myself) about a month or so afterwards. So many people are frightened about this procedure, but from my experience I can tell you it was a GREAT thing in helping me get on with my life!!!! You can e-mail me at madubois63@aol.com if you have any specific questions...

Muldoonmom · 07-18-2006, 05:42 AM

Wow, what a relief to know that the treatment isn't horrible. I have asked my onc if I would have any long term pain or "discomfort" and he has PROMISED me that I would not.... but he's never had it done!
And to be able to paint a room! Or even run errands without hitting the wall.... I'd get my life back!
Thank you so much for your response. I feel so much better and if I do have the treatment, I'll make sure that I take an atavan and pain killer before they remove the tube. I've had two lung surgeries with chest tubes so I can relate.
By the way, did the fluid buildup just stop completely??
WHEW... I feel better!

madubois63 · 07-18-2006, 06:07 AM

Eveyone is different, so I can only answer from my experience. I still have a small amount of fluid in my right lung, but it never gets worse. I don't even know it's there. The first few months you will be a walking barometer. When the air pressure changes, so will the pressure on your lungs. It's sort of strange, not terribly uncomfortable -just weird. Yes - you will get your life back quicker than you think. The only pain I had was the pulling of the tube and maybe a day of uncomfort thereafter. After that, it was all uphill. I used to count the steps from the parking lot to the front door of Walmart - rest. Then count the steps to the first register - rest. Then make it to the pharmacy in two more tries...Shortly after the procedure, I was walking the mall!!! Your welcome...you will feel soooooo much better!

judiek · 07-18-2006, 06:09 PM

Debbie,

THis may help you too. I have had mine tapped twice also. I was going to do the procedure but my liver was in trouble and we couldn't afford the chemo break. Likely the chemo knocked it back and I'm hoping it stays that way

Warmly,

Judiek

Chemical Pleurodesis for Malignant Pleural Effusion
Carolyn Clary-Macy, RN, OCN, UCSF Thoracic Surgery

A pleural effusion is an abnormal accumulation of fluid in the pleural space (the area between the two layers (parietal and visceral pleura) covering the lung). When this fluid occurs, it can cause shortness of breath, a fast heart rate (tachycardia) and difficulty breathing, especially when lying flat. These symptoms can occur gradually or suddenly. The diagnosis of a pleural effusion is usually made after obtaining a chest x-ray. Once the diagnosis of a pleural effusion is made, your doctor may recommend that a thoracentesis (removal of a sample of the fluid from the pleural effusion) be done to determine the cause of the fluid accumulation.

This procedure can done in the doctor's office or with CT or ultrasound guidance, under a local anesthetic. A small needle is inserted into the chest and is sent to the cytology department for review. It may take up to 5 days to get the results from this review. Your doctor will discuss the results with you.

Once the diagnosis is made, your doctor may recommend that you see a thoracic (chest) surgeon. This doctor will discuss the treatment options available to you. Usually, if the fluid is causing you to have trouble breathing, the thoracic surgeon may recommend chemical pleurodesis. The goal of chemical pleurodesis is to cause an irritation between the two layers covering the lung. This irritation causes an obliteration of the space between the layers where the fluid accumulated, and prevents further fluid to be able to accumulate there. There are a variety of agents, which can be used including talc and bleomycin. The procedure can be done at the bedside or in the operating room.

The bedside procedure involves the insertion of a chest tube under a local anesthetic. A sedative may be also given, either by mouth or through an intravenous catheter (IV). The chest tube is usually placed in the lower part of the chest, near your underarm. A dressing is applied to around the chest tube and is taped in place. The fluid drains through the chest tube into a collection container called a Pleur-e-vac. This container is usually connected to suction to allow adequate drainage of the fluid. Once the fluid has been adequately drained through the chest tube, a solution of talc (or other agent, depending on the preference of the surgeon) is inserted. The chest tube is then clamped, to keep the talc solution from draining out immediately. You will be asked to change positions in order for the talc to be well distributed throughout the chest. The chest tube is connected to the Pleur-e-vac.

The second option for chemical pleurodesis is to have it performed in the operating room, under video-assisted thoracoscopy (VATS) surgery. This requires a general anesthetic, which is given by an anesthesiologist. After you are asleep, the thoracic surgeon inserts the thoracoscope through a small incision in your chest. The pleural fluid is removed. If necessary, pleural biopsies can be obtained. A talc solution is then insufflated (blown in) over the lung and pleural surfaces. A chest tube is then inserted and connected to a collection container, which is connected to suction. The chest tube remains in place (with a dressing over it) until the doctor determines the fluid output to be significantly decreased.

An additional treatment option includes having a very small drainage tube inserted by the doctor. This tube is then connected to a portable bulb collection device (called a Pleurex) and you are sent home with it for 2-3 weeks to drain the effusion. Once the fluid is drained, the lung re-expands and eventually pleurodesis occurs this way as well.

Once your doctor determines the drainage is adequately decreased, the chest tube is removed (after a chest x-ray is obtained and confirms there is no significant amount of fluid left in the chest). A dressing is applied over the chest tube site and should be left in place for 24-48 hours, depending on your doctor's preference. It is common to experience a fever after this procedure and you may have some pain at the chest tube site or when taking a deep breath. Pain medication will most likely be prescribed for you. You should avoid taking Ibuprofen, or any anti- inflammatory agents for a period of time specified by your doctor after this procedure to allow irritation necessary to obliterate the pleural space. Ask your doctor when you can restart anti-inflammatory agents if you normally take these. Also be aware that if you are taking pain medicine, you can become easily constipated. Increasing fiber in your diet and eating prunes (or drinking prune juice) can help prevent constipation.

References:

Pearson FG, Deslauriers J, Ginsburg R, Hiebert CA, McKneally MF, Urschel HC(1995) Thoracic Surgery, 1003-1016, 1156-1159.
Hopkins H, Peterson MW, Dayton CS, Beltz E Pleural Effusions and Chemical Pleurodesis, (1997) University of Iowa website: http://www.vh.org/Providers/Teaching...lEffusion.html

postamble();

Muldoonmom · 07-19-2006, 08:22 AM

Hi Judiek,

Again, Wow! Thank you for taking the time to send me that terrific article on pleuradesis. I see my onc tomorrow and feel so much better and better informed.
This is a great support forum. I'm so glad I found all of you!

CLTann · 07-19-2006, 02:29 PM

My sister underwent pluedesis using talc as the irritant. Then they strapped her on a rotating device so that talc could be evenly distributed. It took about 2 to 3 days for the drainage to stop.

After this procedure, there would be no pleural effusion.

I often wonder why do we need the pleural space in the first place. After closing the space, she had no ill effects.

Ann