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Eliana Muis

M. Harun Iskandar

Subdivisi Pulmonologi / Bagian Ilmu Kedokteran Respirasi

Fakultas Kedokteran Universitas Hasanuddin

Makassar

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Definition

Pleurodesis is a medical procedure in which

the pleural space is artificially obliterated

Pleurodesis is a long-term symptomatic

therapy (paliative treatment) and is expected

to improve the patients quality of life, also

daily activities

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Indication

Pleurodesis is performed to prevent

recurrence of pneumothorax

Pleurodesis is performed to prevent

recurrent pleural effusion

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Contraindication

No absolute contraindication for pleurodesis

Contraindicated in negative pressure induced

effusion (worsening symptoms during pleural

evacuation) :

Endobronchial obstruction

Thick pleural peel with trapped lung

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Methods

Chemical tetracycline, doxycycline,

bleomycin, povidone iodine, slurry talc

Surgical pleurectomy, thoracoscopic talc

pleurodesis

Radiotherapy radioactive gold, external

radiation

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Chemical Pleurodesis

Chemicals such as bleomycin, tetracylcine,

povidone iodine, or a slurry of talc can be

introduced into the pleural space through a

chest drain.

The instilled chemicals cause irritation

between the parietal and the visceral layers of

the pleura which closes off the space betweenthem and prevents further fluid from

accumulating.

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Chemical Pleurodesis

Povidone iodine is equally effective and safe

as talc, and may be preferred because of easy

availability and low cost.

Chemical pleurodesis is a painful procedure,

so patients are often premedicated with a

sedative and analgesics. A local anesthetic

may be instilled into the pleural space, or anepidural catheter may be placed for

anesthesia.

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Malignant pleural effusion

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Massive pleural effusion

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Special considerations

1. Are the symptoms (especially dyspnoea)

directly related to the effusion?

Thoracocentesis should relieve the patients

symptoms of dyspnoea

If dyspnoea is due to parenchymal involvement,

thoracocentesis will not reduce the symptoms

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2. Is the effusion reccurent?

This is commonly thought to be an important

issue for consideration of pleurodesis

Some clinicials suggested that pleurodesis be

attempted sooner rather than later during the

course of the disease

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3. Is the lung re-expandable?

The presence of a trapped lung should be

suspected by the finding of very low pleural

pressures as fluid is withdrawn duringthoracocentesis

It is recommended that measurement of pleural

fluid pH be used as a first approach to assess

multiple factors in evaluating a patient prior to

pleurodesis

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4. What is the life expectancy?

Aggressive techniques, such as pleurodesis,

should not be attempted in patients whose

expected survival is short

Certain clinical parameters (e.g Karnofsky index)

can be of help in making decisions

Pleural fluid glucose and pH determinations arevery useful in selecting patients as candidates for

pleurodesis

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Stages of pleurodesis

1. Installment of WSD

2. Pleurodesis

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Identifikasi tempat dilakukan pemasangan WSD,

aseptik dan lokal anastetik

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Insisi dg lebar 1-2 cm dan pelebaran klem

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Hecting

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Insersi WSD (menggunakan trocar 22/24/28)

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Setelah cairan keluar dilakukan pengikatan

dengan benang yang telah dipersiapkan

sebelulmnya

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Bila produksi cairan pleura minimal (

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Technique of pleurodesis

Informed consent

Instillation with Lidocaine (5 amp of Lidocaine

+ 100 cc NaCl 0,9%)

The patients is moved in variety of positions

so that the anesthetic spread evenly in the

pleural cavity

Position: supine, prone, lateral, prostration,

etc

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Technique of pleurodesis

The sclerosing agent then instilled (e.g.

bleomycin 15 mg (3 vial) + NaCl 0,9% 100 cc)

Then the patients is moved in variety of

positions so that the agent spread evenly in

the pleural cavity (position: supine, prone,

lateral, prostration, etc)

WSD clamped + 24 hours and then streamed

Prescribed analgetic

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Monitoring after pleurodesis

CXR AP control

Vital signs

Daily monitor of chest tube drainage

Monitor of air leak Change the bandage after 48 hr

Pain management

Spirometry (if needed)

Mobilization

Consider to remove the chest tube if the fluid

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Complications pleurodesis

Pain

Tachycardia, tachypneu, pneumonitis, respiratory

arrest (especially after insertion of slurry talc),

re-expansion lung oedem Fever, due to pleuritis

Incomplete lung expansion & partially trapped lung

Drug reaction Neurogenic shock

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Documents

274357029-Pleurodesis