Pleurodesis

Pleurodesis is a procedure where a mildly irritant chemical is introduced into the space between the inner wall of the chest and the outer lining of the lung (pleural space). This is done to prevent the recurrence of a lung collapse from accumulation of air (pneumothorax) or fluid (effusion) in the pleural space.

The procedure can be done in two different ways:

  • Chemically – This involves putting chemicals such as bleomycin, tetracycline, povidone iodine or aerosolized talc into the pleural space. These chemicals will irritate the lining of the lungs causing it to inflame and stick to the chest wall thus stopping the re-accumulation of air or fluid. This is somewhat painful so general anaesthesia will be used during the procedure
  • Surgically – This involves irritating the inner wall of the chest using a rough pad to provoke some bleeding that also causes the lung to stick to the chest wall.

Indication for Pleurodesis

Accumulation of fluid or air in the pleural space may cause difficulty in breathing by causing the lung to collaspe. By draining the air or fluid and then performing a pleurodesis, breathing will be improved and the lung should remain expanded. It should also prevent the re-accumulation of fluid or air in the future.

Procedure

You will be placed under general anaesthesia and a large tube will be inserted in your airway that allows selective ventilation of one lung while the other is being operated on and is allowed to collapse. Small incisions will be made in your skin along the side of your chest. Through the incisions, a thoracoscope (camera) is inserted that sends images to a video-screen to serve as a guide in doing the surgery. A suction catheter is placed through one of the incisions to drain fluid out of the space between the lung and the chest wall. Once the pleural space has been inspected using the camera and any necessary samples of tissue are obtained, talc is instilled through the small incisions into the pleural space. Alternatively a rough pad is used to scrape the inner lining of the chest but this can be less effective than using talc. One or 2 drainage tubes are then placed through the incisions and any remaining incisions are closed. The lung is then re-expanded and you are woken from the anaesthetic.

The chest drains will remain in place for 2-3 days following the procedure to provide some suction in the pleural space to ensure the lung sticks to the chest wall.

Risks

Like any other medical techniques, this also involves certain risks such as:

  • Chest pain
  • Fever
  • Difficulty in breathing
  • Infection
  • Air leaking from the lung
  • Blood clots in the legs that can go to the lungs

Recovery

  • Medication treatment. Follow the medication given by Dr Orr and inform your doctor if you are allergic to any medicines. If the pain continues, inform the doctor right away so you will be given another type of painkiller
  • Test. Strenuous activities may cause the stitch to come apart so, resume in your daily activities one at a time
  • Breathing exercises. It is important to ensure that the lungs remain well expanded to prevent collapse and infection. Follow the instructions of the nursing staff and physiotherapists

Alternatives

Pleurodesis generally requires you to stay in the hospital for a longer period but the doctor may recommend a small flexible tube (indwelling pleural catheter) to be surgically inserted in the chest where you can go home with it and be taught how to drain it or a nurse will visit you at home to assist with draining the fluid from the catheter.

  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital