Name of the Procedure:

Pleural Drainage, Percutaneous, with Insertion of Indwelling Catheter; without Imaging Guidance
Common Name(s): Thoracentesis, Chest Drain Insertion

Summary

Pleural drainage is a medical procedure where a doctor uses a needle to remove excess fluid from the space between the lungs and the chest wall (the pleural space). An indwelling catheter, a small flexible tube, is inserted to allow continuous drainage of fluid without using imaging technologies like X-rays or ultrasound.

Purpose

Pleural drainage aims to relieve symptoms such as shortness of breath and chest pain caused by the accumulation of fluid in the pleural space (pleural effusion). The primary goal is to improve breathing and comfort for the patient.

Indications

Pleural drainage may be necessary if a patient has:

• Symptoms such as difficulty breathing, chest pain, or coughing due to pleural effusion.
• Conditions like congestive heart failure, pneumonia, cancer, or liver cirrhosis that cause fluid buildup in the pleural space.
• Unexplained pleural effusion needing diagnostic sampling and drainage.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Blood tests to check for clotting issues and imaging studies to assess fluid volume may be required.
• Patients should disclose any medications they are taking, as some might need to be paused.

Procedure Description

1. The patient is positioned sitting upright or lying slightly elevated.
2. After numbing the skin with local anesthesia, the doctor inserts a needle into the pleural space.
3. Fluid is drained through this needle, and an indwelling catheter is inserted for continued drainage.
4. The catheter is secured in place, and connected to a drainage system.
5. The procedure does not use real-time imaging to guide needle and catheter placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Pleural drainage is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Interventional radiologist or pulmonologist (doctor performing the procedure).
• Nurses to assist during and after the procedure.

Risks and Complications

• Infection at the catheter insertion site.
• Bleeding or bruising.
• Collapsed lung (pneumothorax).
• Pain or discomfort during or after the procedure.
• Possible blockage of the drainage catheter.

Benefits

• Relief from symptoms like shortness of breath and chest pain.
• Increased lung function and improved quality of life.
• Immediate benefits are usually noticeable within a few hours after the procedure.

Recovery

• Patients may stay in the recovery area for a few hours for monitoring.
• Routine care of the catheter site and monitoring for signs of infection are necessary.
• Follow-up appointments to assess fluid drainage and lung function are required.

Alternatives

• Imaging-guided pleural drainage for more precise fluid removal.
• Surgical options like pleurodesis to prevent fluid reaccumulation.
• Continuous suction drainage with different types of systems.
• Pros: Non-imaging guidance may be quicker and more accessible.
• Cons: May be less precise compared to imaging-guided methods.

Patient Experience

• Patients may experience a stinging sensation from the local anesthesia and pressure during catheter insertion.
• Pain is generally manageable with over-the-counter pain medication.
• Discomfort might persist for a few days, but significant pain should be reported to the doctor.

Pain management strategies, including prescribed medications, will be discussed to ensure the patient remains comfortable during the recovery period. Patients should be encouraged to maintain a healthy lifestyle and engage in light activities as advised by the healthcare team.