Pleurodesis in the treatment and care of mesothelioma patients

Pleurodesis is a common surgical procedure that is performed to stop either fluid or air from accumulating between the tissues that cover the lung and the delicate pleural space (commonly known as the chest wall). This detrimental buildup of fluid or air can make it extremely difficult for the lung to expand fully. Pleurodesis basically is employed to prevent this buildup of fluid around the lung.

The area between the outer surfaces of each lung is called the visceral pleurae; the membrane that surrounds each lung is referred to as the parietal pleurae. In a healthy body, these pleurae are moistened with pleural fluid which allows movement of the lungs within the chest cavity. However, fluid can accumulate in the pleural space (pleural effusion), most typically as the result of cancer. Pleurodesis works to counter this fluid build up by causing the pleurae to stick together, thus eliminating the pleural space.

Pleurodesis can be performed in either a surgical setting (in the operating room under general anesthesia) or at the bedside (under local anesthesia). The patient may be awake during the procedure.

Pleurodesis begins by removing all pleural fluid via the insertion of a chest tube into the pleural space. This procedure is known as a thoracostomy. The chest tube remains in place until all pleural fluid is successfully removed. This may take a period of days to achieve, thus the patient may be allowed to return home until a chest x-ray confirms that the fluid has been successfully removed in its entirety.

The next stage involves injecting a sclerosant or sclerosing agent into the plural space via the chest tube. A narcotic pain reliever is administered to the patient, while a pain reliever such as lidocaine is added to the sclerosant for maximum pain relief. The most common agent is talc, while nitrogen mustard, quinacrine, doxycycline, or bleomycin are also widely used for this purpose. Sclerosants or sclerosing agents work to irritate the pleurae, resulting in inflammation that in turn will cause the pleurae to become stuck together. This action eliminates the pleural space, and therefore no more fluid can accumulate.

The tube is closed after the sclerosant has been injected. Once the sclerosant has had time to work its way throughout the pleural space (as much as two hours later), the chest tube is opened back up and the sclerosant is removed by suction. The chest tube remains in place for three to four more days while any remaining fluid is allowed to drain out. Once draining is accomplished, the chest tube is completely removed and the insertion site is sutured shut.
Patients are given aftercare instructions for nursing the wound until it is healed. Notable signs of infection for the wound site include drainage, redness, or swelling. The patient is given medications to both guard again infection and to manage any pain felt during their recovery.
The most typical side effect from pleurodesis is pain, which can usually be managed with a narcotic pain reliever.

There are possible complications for any pleurodesis procedure, but they are uncommon. These include infection, acute respiratory distress syndrome, bleeding, respiratory failure, and lung collapse. The type of schlerosant used may harbor added complications: talc may cause pain and fever; bleomycin can cause fever, nausea, and pain; and quinacrine can cause hallucinations, fever, and reduced blood pressure.

Pleurodesis accompanied by tubal thoracostomy remains the most effective means to treat fluid accumulation in the pleural area as well as prevents a reappearance of fluid build up. Pleurodesis greatly relieves symptoms while helping the patient achieve a better quality of life.