96440 Chemotherapy administration into pleural cavity, requiring and including thoracentesis

Name of the Procedure:

Chemotherapy administration into pleural cavity, requiring and including thoracentesis
Common name: Intrapleural chemotherapy

Summary

Intrapleural chemotherapy is a procedure where chemotherapy drugs are administered directly into the pleural cavity (the space between the lungs and the chest wall) after performing a thoracentesis, which is a technique used to remove excess fluid from this space.

Purpose

Intrapleural chemotherapy is used to treat malignant pleural effusion, a condition where cancer causes an abnormal accumulation of fluid in the pleural cavity. The goals are to relieve symptoms like shortness of breath and to treat cancer more directly in the pleural space.

Indications

• Malignant pleural effusion
• Lung cancer, breast cancer, or other cancers that have metastasized to the pleura
• Symptoms such as severe shortness of breath and chest discomfort

Preparation

• Fasting for a few hours before the procedure may be required.
• Blood tests and imaging studies (e.g., chest X-ray, CT scan) to assess the condition of the pleural cavity.
• Discontinuation or adjustment of certain medications as advised by the healthcare provider.

Procedure Description

1. The patient is positioned sitting or lying down.
2. Local anesthesia is administered to the site where the needle will be inserted.
3. Thoracentesis is performed: A needle or small tube (catheter) is inserted into the pleural space to remove excess fluid, creating space for the chemotherapy drugs.
4. The chemotherapy drugs are then injected through the catheter into the pleural cavity.
5. The catheter may stay in place temporarily to allow for drainage and multiple chemotherapy administrations.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

This procedure is typically performed in a hospital or outpatient clinic.

Personnel

• Interventional radiologist or pulmonologist to perform the thoracentesis
• Oncologist to administer the chemotherapy
• Nurses to assist with the procedure and post-procedure care

Risks and Complications

• Common: Pain at the insertion site, mild bleeding, transient nausea.
• Rare: Infection, pneumothorax (collapsed lung), severe bleeding, allergic reaction to chemotherapy drugs.

Benefits

• Provides direct delivery of chemotherapy to the pleural cavity, increasing drug efficacy.
• Rapid relief from symptoms like breathlessness.
• May reduce the need for repeated thoracentesis procedures.

Recovery

• Post-procedure monitoring for complications such as infection or pneumothorax.
• Instructions on wound care and signs of complications to watch for.
• Follow-up appointments to assess efficacy and plan further treatment.

Alternatives

• Systemic chemotherapy
• Radiation therapy
• Pleurodesis (a procedure to adhere the lung to the chest wall, preventing fluid buildup)
• Palliative care measures to manage symptoms

Patient Experience

• Local anesthesia minimizes pain during the procedure, but the patient may feel pressure or slight discomfort.
• Post-procedure, the patient might experience temporary soreness at the site and mild nausea.
• Pain management strategies, such as prescribed medications, will be provided to ensure patient comfort.