Pleurodesis treatment

This page is about pleurodesis. There is information about

• Fluid on the lungs (pleural effusion)
• Why you may have pleurodesis
• How you have pleurodesis

When cancer affects the lungs fluid can sometimes collect between the sheets of tissue that cover the outside of the lung and the lining of the chest cavity. These sheets of tissue are called the pleura. You can see the pleura (in red) in the diagram below

Doctors call this fluid collection a pleural effusion, as in the diagram below

The fluid stops the lung from fully expanding when you breathe. So as it builds up, the collected fluid causes shortness of breath.

You can have treatment to stop this fluid from building up and help relieve the symptoms. This treatment is called pleurodesis. It seals the space between the pleura by using sterile talc to make the pleura inflamed so that they stick together. When the pleura stick together there is no space in which the fluid can collect. This procedure can be done as an outpatient. But that may depend on how well you are. You may have to stay in hospital overnight if there is a lot of fluid to drain off. This can take some time and your nurses will want to keep an eye on you.

This treatment does not treat the cancer. But it is very useful for relieving difficult symptoms such as breathlessness. It should be easier to breathe after this treatment. If it doesn't work completely the first time, then you can have it done again.

Your doctor may do the procedure using a tube put into your chest and into the pleura (a thorascope). The doctor can see through the tube using a video and they can insert the sterile powder though the thorascopy tube. This way of doing pleurodesis is called video assisted thorascopy.

If you need to have fluid drained from between the pleura beforehand, your doctor will do the procedure in a slightly different way. They give you a small injection of local anaesthetic. When the anaesthetic has worked, the doctor puts a wide needle (cannula) into your chest, usually through your side. The tip of the needle goes into the space where the fluid is collecting. The needle is attached to a drainage tube called a chest drain and a collecting bottle or bag. Your doctor will put a stitch (called a purse string suture) around the tube to hold it in place.

As long as the drainage bottle or bag is kept lower than your chest, the fluid drains out automatically. If there is a lot of fluid, it can take a while. It has to be slow, because draining off a large amount of fluid too quickly can make your blood pressure drop suddenly and you may feel faint. Or if your lung expands too quickly that can make you feel more breathless.

Once the fluid has stopped draining, the doctor injects the powder into the pleural space through the drain. They clamp the drain and leave it for an hour. During that time, you will be asked to lie in different positions on your bed – for example, on one side and then the other. This is to help the powder circulate between the pleura. After that, the drain may be attached to some suction. This helps the pleura to stick together. This part of the process can be a bit uncomfortable and you may have painkillers to take beforehand. For most people the soreness is mild and doesn't last long. But do tell your doctor if it is a problem for you.

After all this, your doctor or nurse will take the drain out and pull the stitch tight to close the small opening in your chest wall. The stitch stays in for about a week and can then be removed.

The TIME3 trial is looking at using a drug called urokinase to help drain fluid from around the lung to make breathing easier. Sometimes there is more than 1 pocket of fluid between the lung and chest wall. This makes it difficult to drain all the fluid away. Urokinase may help to break down the pockets. The aim of the trial is to see if urokinase can help control and improve shortness of breath caused by pleural effusion and improve the success rate of pleurodesis.