Pleurodesis is a procedure that uses medicine to adhere your lung to your chest wall. It seals up the space between the outer lining of your lung and chest wall (pleural cavity) to prevent fluid or air from continually building up around your lungs.
What’s the purpose of pleurodesis?
You may need pleurodesis if you’ve had a recurring collapsed lung (pneumothorax) or an ongoing buildup of fluid around your lungs (pleural effusion). Normally, you have a little bit of fluid in the pleural cavity — the space between your chest wall and lungs. When there’s too much fluid in that space, your lungs can’t properly expand.
A variety of conditions can cause extra fluid to collect in the pleural cavity, including:
- heart failure
- liver and kidney disease
- inflammation of the pancreas
- rheumatoid arthritis
The buildup of fluid can cause symptoms like pain, coughing, and shortness of breath.
In pleurodesis, your doctor injects a medicine (such as a talc mixture) into the space between your lung and chest wall. There are a variety of substances that can be used. The medicine irritates and inflames the tissue, producing scar tissue that makes the lung stick to the chest wall.
By adhering the lung to the chest wall, pleurodesis eliminates the space where fluid or air could collect. It also helps to keep the lung inflated.
Pleurodesis may be done on its own, or together with a procedure to drain air or fluid from around your lungs (thoracostomy or thoracoscopy).
If you’ll only have pleurodesis, it may be done in your hospital room.
During a pleurodesis procedure:
- You’ll get medicine to control your pain and relax you.
- The chosen medication for pleurodesis will be injected into your chest via a tube.
- You may need to change position about once every 10 minutes or so to ensure the medicine reaches every part of your chest cavity.
If you have pleurodesis with thoracostomy or thoracoscopy, it will be done in an operating room under anesthesia.
During the procedure:
- You’ll get medicine to prevent pain and relax you.
- The doctor will use a local anesthetic to numb the area of your chest where the incision will be made. That area of skin will also be sterilized.
- The doctor will make a small incision and insert a camera for surgery or a narrow tube called a chest tube. Then the fluid will be drained into a collection bag.
- Once the fluid has been drained, talc powder, doxycycline, or another medicine will be injected into the pleural space through the chest tube. The medicine will coat the outside of your lung and create a sticky surface that makes it adhere to the chest wall.
- Your doctor might do an X-ray to confirm that the procedure was successful.
A possible alternative to this procedure is a catheter placement. It allows you to go home with a tube much smaller than a chest tube, and also constantly drains. Your doctor can discuss the pros and cons of a catheter versus the above procedure.
Recovering from pleurodesis
The chest tube will stay in place for 24 to 48 hours, or until your lung has stuck to your chest cavity. If you had a surgical procedure, you may have to stay in the hospital for a few days. You’ll get regular X-rays to check your progress.
After the chest tube is removed, you’ll need to keep the wound clean. Wash it every day with a mild soap and pat it dry.
You may notice some drainage from the wound for a day or two. Keep a bandage over it until it stops draining. Change the dressing at least every day. Follow all wound care and follow up instructions given to you.
Here’s what you shouldn’t do after your procedure:
- Don’t rub the wound. This can slow your healing.
- Don’t put any ointment, lotion, or powder on the incision.
- Don’t take a bath, swim, or sit in a hot tub until the incision has fully healed.
- Don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) for at least seven days after pleurodesis. These drugs can prevent the lung surfaces from sticking together. Ask your doctor what medicines you can take instead to control your pain.
- Don’t lift objects that weigh more than 10 pounds until you get approval from your doctor.
- Avoid straining or holding your breath.
Ask your doctor when you can start to drive again, go back to work, and resume normal activities.
Potential complications of pleurodesis
Risks of the procedure include:
- a collection of pus in the pleural space (empyema)
If you also have a thoracostomy, possible complications can include:
- collapsed lung
- injury to the chest wall, arteries, or lungs
- blood clots
- a tube that moves out of place
Pleurodesis is generally an effective procedure. However, there’s a small chance that the procedure won’t work, and you’ll need to undergo another surgery.
Side effects and outlook
You might feel some pain or soreness in the area where the chest tube was placed for a few days. The soreness may get worse when you take a deep breath.
Other possible side effects include:
- shortness of breath
Check the wound daily, and call your doctor if you have:
- increased redness, swelling, or pain around the incision site
- pus draining from the wound
- a lot of bleeding
- a fever over 100.4°F (39°C)
Your outlook depends on what condition caused you to need pleurodesis. The long-term outlook for people with pneumothorax who are treated with this procedure is good, with improvements in lung function. In small studies, pleurodesis had success rates of around 75-80 percent in people with pleural effusion not caused by cancer.