Pleural effusion

The lungs are covered by a lining (membrane) called the pleura. The pleura has 2 layers:

• The inner layer is called the visceral pleura, which covers the lungs.
• The outer layer is called the parietal pleura, which lines the ribcage and a sheet of muscle called the diaphragm. The diaphragm separates the chest from the tummy (abdomen).

Between the 2 layers of the pleura is a small amount of fluid that acts as a lubricant. It allows the lungs to move in and out smoothly and helps you to breathe easily. Sometimes, too much of this fluid builds up between the 2 layers of the pleura. This is called a pleural effusion.

Common symptoms of a pleural effusion include:

• breathlessness
• a cough
• chest pain.

The build-up of fluid presses on the lung, making it difficult for the lung to expand fully. This can make you more breathless, even when resting. You may also get some chest pain and a cough.

In some situations, part, or all, of the lung will collapse. Usually, when you breathe out there is still some air left in your lungs. But if the lung has collapsed, there is no air left in that part of the lung.

If you are worried about any symptoms, speak to your cancer team or your GP.

A pleural effusion can be managed by removing (draining) the fluid. This can help relieve symptoms.

If there is only a small amount of pleural fluid in the chest, the doctor may insert a small needle or thin tube (cannula) into the chest. They will use a syringe to remove the fluid. After the fluid has drained, the tube is taken out and the area is covered with a dressing.

A pleural effusion is usually drained by putting a tube into the chest. This is called a chest drain. It is put in by a doctor or sometimes a specially trained nurse. They will ask you to sit on a chair, or on the edge of the bed. You will be asked to lean forward over a pillow on a table, so your back is showing.

Your doctor usually puts the tube in the side of the chest. They clean the skin with an antiseptic. They then give you an injection of local anaesthetic to numb the area. You will not feel any pain during the procedure. Sometimes it is done under general anaesthetic, which means you will be asleep.

Your doctor makes a very small cut in the chest. They then put the chest drain into the space where the fluid is collecting. Sometimes they use an ultrasound scan to help guide the tube into the correct position. When the tube is in position, they attach the chest drain to a bag or bottle for the fluid to drain into. The fluid that drains may have a small amount of blood in it.

Pleural effusion with drainage

Fluid is usually drained slowly. This is because a sudden release of pressure in the chest can cause your blood pressure to drop. 1 litre (about 2 pints) of fluid may be drained safely as soon as the drain has been put in. After this, it must be done more slowly. Your blood pressure is checked during the procedure. Tell your doctor or nurse if you feel dizzy, sick or light-headed.

In many hospitals, you can have this done as a day patient by a specialist lung team. Sometimes, you may need to stay in hospital for around 2 days or sometimes longer. This may happen, for example, if it is taking longer for the fluid to drain or if there are any complications.

You may have some pain when the local anaesthetic wears off. Tell your doctor or nurse if this happens. They can prescribe painkillers to help.

The drainage tube is held in place with a small stitch until the fluid has drained. If your drainage tube is attached to a bottle or bag, you will be able to walk about with it. The chest drain may feel uncomfortable at times. Tell your doctor or nurse if it is very uncomfortable.

It is important to be careful with the bottle or bag. It should not be raised above the level of your chest, as the fluid could go back into your lungs.

When the drainage has slowed down, you will have a chest x-ray to see how well your lung has re-expanded. If it has expanded well, the doctor or nurse will remove the drain.