The initial treatment of a pleural effusion involves draining it to relieve the symptoms.
Draining a pleural effusion with a chest drain
A pleural effusion is usually drained by putting a tube, known as a chest drain, into the chest. This procedure is carried out by a doctor. You will be asked to sit either on a chair or on the edge of the bed. Someone will then help you lean forward over a table with a pillow on it so that your back is exposed.
Your doctor will decide where to insert the drain - usually in the side of the chest. The skin over the area where the drain is to be inserted is cleaned with an antiseptic solution to prevent the area from becoming infected. You will then be given an injection of local anaesthetic to numb the area so you won’t feel any pain during the procedure.
Your doctor will then make a very small cut in the chest and insert the chest drain into the space where the fluid is collecting. Sometimes an ultrasound scan is used to help guide the tube into the correct position. Once in position, the chest drain is attached to a bag or bottle for the fluid to drain into. The fluid that drains may be bloodstained.
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. After this, drainage will be carried out more slowly. Your blood pressure will be checked during the procedure. You should let your doctor or nurse know if you feel dizzy, sick or light-headed.
You will usually need to stay in hospital for a couple of days after the procedure. You may have some pain when the local anaesthetic wears off. Let your doctor or nurse know if this happens so that they can prescribe painkillers. The drainage tube will be held in place with a small stitch until all the fluid has drained. If your drainage tube is attached to a bottle, you will be able to walk about with it. It's important to be careful with the bottle; it shouldn't be raised above the level of the chest as the fluid could go back into your lungs.
Once the drainage has slowed down and the doctors think that most of the fluid 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.
It's possible for the fluid to collect again, so drainage may need to be carried out more than once. To prevent the fluid from building up again you may be prescribed chemotherapy or hormonal therapy to treat the cancer. Your doctor may also advise you to have a pleurodesis or a medical thoracoscopy.
Possible complications of chest drains
- The chest drain can become blocked, but this is rare. It can sometimes be cleared by changing your position or sitting upright. Occasionally the drain may need to be replaced.
- The drain can become infected. You will have your temperature checked for any sign that you may be developing an infection.
- Sometimes the drain causes air to become trapped between the lung and the chest wall. This is called a pneumothorax. You may become more breathless and have a sharp pain in your chest. If it's a small pneumothorax, you may not need any treatment and it's likely to clear over a few days. You may need to have an x-ray to check that it's gone. If it's a larger pneumothorax, you may need another drainage tube to remove the air.
Draining a pleural effusion at home
Occasionally, it may be possible to have your pleural effusion drained while you’re at home using a catheter, which acts in a very similar way to a chest drain. The catheter will be put in while you’re in the hospital and then you will be able to go home. Your doctor or specialist nurse will explain more about this method of drainage if it’s suitable for you.
Draining a small pleural effusion
If there is only a small amount of pleural fluid in the chest, the doctor may insert a small needle or cannula into the chest rather than a chest drain. This is removed immediately after the fluid has been drained off and the area is covered with a dressing.