of Pleural Space )
- Massive effusion
- Good symptomatic relief following evacuation
- Reasonable lenth of expected life
- Usual clinical conditions where indicated
- Malignant effusion (Most useful in Cancer breast, Ovarian
malignancy and Lymhoma)
- pH > 7.3 - over 80% success
- Benign - lymphangiomyomatosis, CHF, Cirrhosis,
- Negative pressure induced effusion (worsening symptoms during pleural evacuation)
- Endobronchial obstruction
- Thick pleural peel with trapped lung
- Tetracycline (Not available anymore)
- Bleomycin. Expensive option.
- Nitrogen mustard, Atabrine,
- Thoracoscopic Talc pleurodesis (Current favoured method)
- Radioactive gold: (Used in the past. Requires special dispoition of body because
of radioactive material)
- External Radiation (Loose lung function, not used any more)
- Technique for chemical pleurodesis:
- Primarily works by irritant effect on pleura.
- Tube thoracostomy to completely evacuate fluid to enable irritants to effectively
spread over pleural surface.
- When space is drained or lung expanded, inject 250 mg lidocaine for anesthesia,
reposition patient to get complete anesthesia
- Then inject doxycycline 5-10 mg/kg in 50 ml, flush tube with 50 ml saline
- Reposition patient to contact all pleural surfaces (studies indicate that this
may not be necessary)
- Clamp thetube for 2 hours
- Unclamp tube, and return to suction
- If 24 hour drainage exceeds 200 ml repeat the procedure.
- Pull the chest tube once the drainage is less tha 150 ml in 24 hours.