In order to treat pleural effusions, the two main factors that the doctor will need to consider are the treatment for associated mechanical problems, as well as the treatment of the underlying cause of the pleural effusion. The aim of treating a pleural effusion is to remove the fluid, prevent another buildup of fluid, as well as determine and provide treatment for the cause of the accumulation of fluid. Treatment for a pleural effusion may often simply entail treating the medical condition that causes the pleural effusion. An example would include administering antibiotics for pneumonia or diuretics for congestive heart failure.
In such a case, it is important to also treat the cause of the buildup of the fluid. If this is due to congestive heart failure, the doctor may prescribe diuretics (water pills) as well as other medications for the treatment of heart failure. A pleural effusion that is caused by an infection is treated through the use of antibiotics. Individuals suffering from cancer or infections may have their condition treated through the use of a chest tube that is inserted into the pleural space for several days to allow for drainage of the fluid. In certain cases, small tubes may be left in the pleural cavity for a long period of time in order to drain the fluid. The expected outcome of this treatment is dependent on the underlying disease. In some cases, the following procedures may be performed:
- Radiation therapy
- Putting medication into the chest for the prevention of the buildup of fluid again following its drainage
The initial treatment of pleural effusions will involve draining them in order to provide symptom relief. A variety of procedures may be used in the treatment of a pleural effusion, including:
A large, infected or inflamed pleural effusion will often entail drainage for purposes of improving symptoms and preventing complications. This involves the removal of large amounts of fluid, which is effective in treating many pleural effusions. This procedure is commonly carried out in the event that there is a lot of fluid which is causing pressure in the chest, shortness of breath, as well as other breathing problems such as the low oxygen levels. Removal of the fluid allows for the expansion of the lung, thereby enabling the patient to breathe easier.
Draining Pleural Effusions Using a Chest Drain
When treating pleural effusions that recur repeatedly, the doctor will insert a long-term catheter into the pleural space through the skin. A patient with a pleural catheter is able to periodically drain the pleural effusion in the comfort of their own home.
A pleural effusion is usually drained by inserting a tube called a chest drain into the chest. This procedure is performed by a doctor. The doctor will ask you to sit either on a chair or on the edge of the bed. A nurse will then assist you in leaning forward over a table with a pillow placed on it, such that your back is exposed.
The doctor will decide on where to insert the drain, which is usually in the side of the patient’s chest. The skin over the area on which the drain is to be inserted will then be cleaned using an antiseptic solution in order to prevent an infection from occurring in the area. The doctor will then give you an injection of local anesthetic to numb the area such that you do not feel any pain during the procedure.
The doctor will thereafter make a very small cut in the chest and then insert the chest drain into the space in which the fluid is accumulating. In some instances, an ultrasound scan may be used to help in guiding the tube into its correct position. Once it is in position, the chest drain is attached to a bottle or bag for the fluid to drain into. The fluid that drains out may have bloodstains.
This fluid is usually drained off fairly slowly because a sudden release of pressure in the chest cavity may result in a drop in blood pressure. It is possible to safely drain out a liter of fluid as soon as you insert the drain. Thereafter, the drainage is carried out more slowly. During this procedure, the blood pressure of the patient is checked. It is important to inform your doctor or nurse if you feel sick, dizzy or light-headed.
After the procedure, the patient will typically need to remain in hospital for several days. You may experience some pain once the local anesthetic wears off. Inform your doctor or nurse in the event that this happens such that they can prescribe painkillers for you. The drainage tube is held in place with a small stitch until drainage of all the fluid is concluded. If the drainage tube is attached to a bottle, the patient is able to walk around with it. It is important to take extra care with this bottle. Avoid raising it above the level of the chest as the fluid could flow back into the lungs.
Once the drainage has slowed down and your doctor thinks that most of the fluid has been drained out, they will perform a chest x-ray in order to see how well your lung has re-expanded. If it has, the doctor may remove the drain.
Due to the possibility of the fluid collecting again, drainage may have to be performed more than once. In order to prevent the fluid from accumulating again, the doctor may prescribe hormonal therapy or chemotherapy to treat your cancer. The doctor may also recommend that you undergo a pleurodesis or a medical thoracoscopy.
Possible Complications of Chest Drains
- The chest drain may become blocked, although this is a rare occurrence. This may sometimes be cleared simply by sitting upright or altering your position. The drain may need replacing occasionally.
- The drain may become infected. The doctor will check your temperature for signs that you may be developing an infection.
- In some cases, the drain may cause air to get trapped between the chest wall and the lung. This is referred to as pneumothorax. The patient may become more breathless and experience a sharp pain in the chest. If it’s a small pneumothorax, you may not require any treatment as this is likely to clear up in a couple of days. You may need to have an x-ray performed in order to confirm that it is gone. For a larger pneumothorax, you may require another drainage tube for the removal of air.
Draining a Pleural Effusion At Home
Occasionally, it may be possible to have the pleural effusion drained while the patient is at home, through the use of a catheter, which serves a similar purpose as the chest drain. The catheter is inserted while the patient is in hospital and then they are allowed to go home. Your doctor or specialist nurse can explain more about whether this drainage method is suitable for your condition.
Draining a Small Pleural Effusion
If you only have a small amount of pleural fluid in your chest, the doctor may insert a cannula or a small needle into the chest instead of a chest drain. This is immediately removed after drainage of the fluid has been carried out and the area is then covered using a dressing.
If the lung becomes re-inflated after drainage of the fluid, it may be possible to seal the two pleura layers together in order to prevent the buildup of fluid once again. This is referred to as pleurodesis. This is usually done through the use of sterile talc that is injected through the drain.
During this procedure, the doctor injects an irritating substance such as talc or doxycycline into the pleural space through a chest tube. The substance results in an inflammation of the pleura and chest wall, which will then bind to each other tightly during the healing process. In many cases, pleurodesis may prevent the recurrence of pleural effusions.
The doctor will inject the drug through the drain and then leave the drain clamped for approximately one hour. They will ask you to lie in various positions on the bed – on your front, back, and your right and left sides. These positions are designed to help in circulating the drug around the lining of your lungs. The doctor may attach the drain to a suction machine in order to apply a small amount of pressure, which will encourage the sealing together of the pleura. Following the pleurodesis procedure, the drain will typically be kept in place for the next 24 hours.
If there was a stitch holding the drain in, this may be pulled together once the drain is removed, thereby sealing the hole. The hole may thereafter be covered using a dressing. The stitch is typically removed after about one week. In some instances, the doctor may only use a dressing to cover the area in which the drain had been inserted. After the pleurodesis, you may experience chest pain for one or two days which may entail taking painkillers. In the event that your doctor recommends that you undergo a pleurodesis, they will provide you with more information about the procedure.
It may be possible to drain a pleural effusion and carry out a pleurodesis through a procedure referred to as a medical thoracoscopy. A flexible tube or thorascope is inserted into the chest through a small cut that is made in the chest wall. A light and a camera are attached at the end of this tube in order to enable the doctor to see the area clearly.
The doctor will ask you to lie on your side and then give you an injection of a sedative that will make you feel drowsy. They may give you a local anesthetic to numb the area on which they will make one or two small cuts. The thorascope is then inserted into the chest. This will allow for drainage of any fluid that is present in the chest. The doctor may thereafter spray sterile talc through the thoracoscopy tube to enable the sticking together of the pleura layers. This procedure will last for about 40-60 minutes.
Upon completion of the thoracoscopy, the doctor will insert a plastic tube or chest drain through the cut to allow for the drainage of the remaining fluid. The drain is attached to a bag or a bottle and secured in place with a stitch. The patient is typically able to go home two to five days following the thoracoscopy. Your team of doctors will provide you with more information about this procedure.
A pleural effusion that cannot be managed with draining or pleural sclerosis will require surgical treatment referred to as Pleural Decortication. Here, the surgeon may carry out an operation inside the pleural space in order to remove potentially unhealthy tissue and dangerous inflammation. Decortication may be performed by making small incisions (thoracoscopy) or a large one (thoracotomy).
The two types of surgery available for treating pleural effusions are:
- Video-assisted thoracoscopic surgery or VATS – This is a minimally invasive approach that involves the making of 1-3 small (approximately ½ inch) incisions in the chest.
- Thoracotomy – Also referred to as traditional “open” thoracic surgery, this procedure is performed by making a 6-8 inch incision in the chest and is recommended for pleural effusions in which an infection is present. A thoracotomy is performed in order to remove all the fibrous tissue and assists in the evacuation of the infection from the pleural space. The patient will need to have chest tubes inserted for at least 2 weeks following surgery in order to allow for the uninterrupted drainage of the pleural fluid.
- Tube thoracotomy (chest tube): The doctor makes a small incision in the chest wall and inserts a plastic tube into the pleural space. They then attach chest tubes to suction which will often remain in place for a few days.
Before beginning, the surgeon will carefully evaluate your condition in order to determine the safest treatment option, as well as discuss the possible risks and benefits of every treatment option available.
Certain complications may occur during the treatment of pleural effusions. These include:
- Lung damage
- Pneumothorax (air in the chest cavity) following a thoracentesis procedure
- Infection that transforms into an abscess known as an empyema, which will require drainage through the use of a chest tube
In the event that you continue to experience any symptoms of pleural effusion following treatment, you should consult your health care provider. You should also call your doctor or go to the emergency room if difficulty breathing or shortness of breath occurs immediately after thoracentesis.