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Management of a pleural effusion

This section has been written to help you to understand more about
pleural effusion. We hope it will answer any questions you may have. If you have
any further questions about pleural effusions do talk to your doctor or nurse.

What
is a pleural effusion?

What
causes a pleural effusion?

Signs
and symptoms

Drainage
of a pleural effusion

Pleurodesis

What is a pleural effusion?

The lungs are covered by a membrane or lining called the pleura which has two
layers, an inner layer and an outer layer. The outer layer lines the rib cage
and diaphragm (which separates the chest from the abdomen), and the inner layer
covers the lungs. The pleura produce a fluid that acts as a lubricant that helps
you breathe easily, allowing the lungs to move in and out smoothly. Sometimes an
excess of this fluid can build up between the two layers and this is called a
pleural effusion.

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What causes a pleural effusion?

Pleural effusions are quite common and are often due to infections, such as
pneumonia, or heart failure, when the heart is not pumping the blood efficiently
around the body.

A pleural effusion can also be a symptom of several types of cancer. This
usually develops if cancer cells have spread to the membrane lining the lungs,
where they can lead to irritation and cause fluid to build up. The types of
cancer that are more likely to cause a pleural effusion are lung
cancer, breast cancer, lymphomas and mesothelioma (cancer of the lining of the lungs).

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Signs and symptoms

The build-up of fluid around the lungs presses on the lung, making it very
difficult for the lung to expand fully. It can make you increasingly breathless,
not only on exertion but at rest as well. You may also get some chest pain and a
cough.

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Drainage of a pleural effusion

The treatment of a pleural effusion involves slowing the build-up of the
fluid, and draining the fluid to relieve the symptoms.

The drain is usually inserted by a doctor. You are asked to either sit on a
chair or on the edge of the bed and you are usually asked to lean over a table
with a pillow to lean on. The area where the drain is to be inserted is cleaned
with an antiseptic solution to prevent the area from becoming infected. The
doctor then gives you an injection of local anaesthetic to prevent the procedure
from being painful.

When the area has been anaesthetised the doctor makes a very small cut in the
chest and inserts a needle called a cannula. The cannula is attached to a tube
and drainage bag or bottle. The fluid drains out of the chest and collects
inside the bag or bottle. The fluid drained may be bloodstained. If there is a
large amount of fluid, you will need to stay in hospital usually for a couple of
days. If there is only a small amount of fluid, the cannula is removed
immediately after the fluid has been drained off and the area is covered with a
dressing. Otherwise, it will be held in place with a small stitch.

When the local anaesthetic wears off, you may have some pain or discomfort.
Let the doctor or nurse know if you have any pain, as you can be prescribed
medication to help.

Once the drainage has settled down and the doctors think that most of it has
drained, you will have a chest x-ray to see how well your lung has re-expanded.
If it has, the drain will be removed.

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Pleurodesis

A drug called bleomcyin or tetracycline or sometimes talc is injected through
the drain to help seal the two layers of the pleura together to prevent the
fluid from building up again. This is known as pleurodesis.

The doctor injects the drug through the drain and then leaves the drain
clamped for approximately one hour. You will be asked to lie in various
positions in the bed eg. on your back, your front, your left side and your right
side to help the drug circulate around the covering/lining of the lungs. Then
the drain may be attached to a suction machine which will apply a small amount
of pressure to encourage the pleura to become sealed together.

When the drain is removed, the stitch is pulled together, sealing the hole,
and the stitch is usually removed approximately a week later. The area is
covered with a small dressing. It is possible for the pleural effusion to
re-accumulate, and drainage may need to be performed more than once.

The doctor may also prescribe a diuretic (water tablet). This can result in
you wanting to pass more urine than normal but will slow down the build up of
the pleural effusion.

The doctor may also prescribe some chemotherapy or hormone therapy to treat
the cancer and help prevent the fluid from building up again.

Additional information

Usually the fluid will be drained off fairly slowly as a sudden release of
pressure in the chest can cause a drop in blood pressure. A litre of fluid may
be drained safely as soon as the drain has been inserted.

Following this, drainage should be more slowly. Your blood pressure will
be checked during the procedure.

The chest drain can become blocked. This can sometimes be resolved by
changing position or sitting upright. Occasionally the drain may need to be
replaced.

The drain is also a possible source of infection. You will have your
temperature checked for signs of developing an infection.
If a pleurodesis
is necessary this can sometimes cause chest pain for a day or so after
treatment and you may need to take painkillers.

If your drainage tube is attached to a bottle, you will be able to walk
about with it. It is important to be careful with the bottle and it should not
be raised above the chest as the fluid could go back into your lungs.

For more information call CancerBACUP's Cancer Support Service on 020 7613
2121 or Freephone 0808 800 1234 to speak to a cancer specialist nurse. Lines are
open Monday-Friday, 9am-7pm.

This information has been compiled using information from a number of
reliable sources including the Oxford Textbook of Oncology, Souhami and Tobias
and The Textbook of Uncommon Cancers.

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Content last reviewed: 01 November 2002
Page last
modified: 04 November 2003

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