Pleurodesis

Pleurodesis is used as a possible treatment for complications from lung cancer, but it may also be recommended for other health conditions that cause difficulty breathing. It’s a medical procedure designed to stop fluid or air from collecting in the pleural space—the space between the lung and chest wall.

Pleurodesis may prevent two conditions: pleural effusion and pneumothorax.

• Pleural effusion is sometimes referred to as water in the lungs. It’s a buildup of fluid in the pleura, the thin membranes that line the lungs and chest cavity to help with breathing.
• Pneumothorax is a collapsed lung. It may occur when air gets into the space between the lung and chest cavity. The air pushes the outside of the lung, causing the lung to collapse.

Both pleural effusion and pneumothorax may be caused by lung cancer or cancer that has metastasized (spread) into the lungs. Pleurodesis is performed to provide relief when patients are experiencing shortness of breath and discomfort.

Ahead of the procedure, doctors typically provide instructions on what to do in advance. Guidelines may require patients to:

• Stop eating and drinking for a set number of hours before the procedure
• Notify doctors about all their medications, including blood thinners, aspirin, vitamins and other prescription and over-the-counter medicine
• Arrange a ride home from the hospital, since anesthetic and pain medicine may leave patients feeling tired, foggy and unable to drive

This procedure may be performed in one of two ways:

• Chemical pleurodesis—The doctor makes a small incision in the chest and inserts a chest tube to remove any fluid from the pleural cavity. A substance is then inserted into the tube that causes the linings of the lung and chest wall to stick together. This seals the space and limits further fluid buildup. Common drugs used for this include medical talc, doxycycline or a chemotherapy drug such as bleomycin.
• Surgical pleurodesis—The doctor makes a small incision and inserts medical talc into the space around the lungs using a thoracoscope, a hollow tube with a light and camera on the end.

Patients typically require a few stitches to close up the incision site.

Although pleurodesis is considered safe, there are always risks with any medical procedure. Some complications associated with pleurodesis include:

• Chest pain and discomfort—Patients may experience chest pain after the procedure, but this is usually treated with pain medication.
• Fever—A day or two after pleurodesis, patients may notice they’re running a fever. Doctors may monitor this and provide medication if needed.
• Breathing problems—Breathlessness and difficulty breathing sometimes occur as a result of inflammation in the lung. With the help of oxygen, breathing typically returns to normal in a few days.
• Infection—Because a tube is inserted into the chest for pleurodesis, there’s a small risk of infection, which would be treated with antibiotics.

Following the procedure, patients are urged to call their doctor in case of any issues or 911 for serious concerns.

After pleurodesis, a patient may stay in the hospital overnight for observation. This is an important way to ensure recovery is going as planned. Several follow-up appointments may be scheduled as well, including procedures such as X-rays to see whether treatment is working and discussions about any additional recommended treatments.