What is Pleurodesis?
Pleurodesis is a treatment option for pleural mesothelioma patients who aren’t eligible for more aggressive surgeries. This procedure can help treat pleural effusion or fluid buildup in the lungs, which is a common problem in mesothelioma patients.
A major symptom of pleural mesothelioma is the buildup of fluid in the pleura, which is located between the layers of tissue that line the lungs and the chest wall. Pleural effusion can lead to coughing, chest pain, and breathing difficulties. If left untreated, it may cause infection or a collapsed lung.
During pleurodesis, specific medicines are injected into the chest cavity between the lungs and chest wall. The medicine creates irritation and swelling in between the two layers and adheres them to the chest wall, stopping the buildup of fluid or air.
Pleurodesis may be used as a standalone treatment or combined with another procedure to drain air or fluid around the lungs, called a thoracostomy or thoracoscopy. This procedure is done in the patient’s hospital room. If a thoracostomy or thoracoscopy is combined with pleurodesis, the procedure takes place in an operating room.
- Medicine is given to control pain and help the patient relax.
- A surgeon inserts medicine (doxycycline or talc) into the chest cavity.
- The patient changes their position every 30 minutes to move the medicine around.
- The patient is able to administer their own pain medicine, called patient analgesia.
- The patient is given medicine to prevent pain and will be put under anesthesia.
- The doctor inserts a small camera for surgery into the chest area or a narrow tube.
- The fluid is drained into a collection bag and medicine is injected into the pleural space.
Regardless of where the procedure happens, a chest tube will remain in place for up to 48 hours to ensure the lung sticks to the chest wall. Once this is accomplished, it prevents fluid buildup and reduces pain. Patients receive daily x-rays to check this progress.
After the procedure, the chest tube stays in place for 24 to 48 hours, or until the lung has adhered to the chest cavity. Patients who undergo surgery may be required to stay in the hospital so a medical team can track their progress.
Once the chest tube is removed, patients must clean the wound every day. There may be some extra drainage at first, but keeping a bandage over it and changing the dressing regularly will keep the area clean.
Patients should avoid using lotion, taking baths, swimming, or sitting in hot tubs during the recovery process. Patients may also need to take prescriptions to help control pain.
Alternatives to Surgery
There are other options for mesothelioma patients suffering from pleural effusion or fluid buildup. In a catheter placement procedure, the doctor places a small tube called an indwelling pleural catheter into the patient’s chest. The catheter allows the patient to go home with the small tube and drain the fluids there.
Another alternative to pleurodesis is removing excess fluid with a needle. This procedure doesn’t require a chest tube. However, this method isn’t permanent, and fluid is likely to return and may require further treatment.
Potential Surgical Complications
Pleurodesis is an effective procedure. However, there are some risks, which include:
- Collection of pus in the pleural space
Possible complications of a thoracostomy:
- A tube that moves out of place
- Blood clots
- Collapsed lung
- Injury to the chest wall, arteries, or lungs
Patients will likely experience some pain or soreness in the area where the chest tube was placed. Other possible side effects include fever, shortness of breath, and infection.