32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance

Name of the Procedure:

Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance (Common names: Thoracentesis with catheter placement, Pleural catheter insertion)

Summary

Pleural drainage with indwelling catheter insertion and imaging guidance is a minimally invasive procedure used to remove excess fluid from the space around the lungs (the pleural space). A thin tube is placed into the pleural space to drain the fluid, and imaging techniques like ultrasound or CT are used to guide the placement of the catheter.

Purpose

This procedure is used to treat pleural effusion, a condition where excess fluid accumulates around the lungs, causing difficulty breathing and discomfort. The main goal is to relieve symptoms, improve breathing, and prevent further fluid buildup.

Indications

• Persistent cough
• Shortness of breath
• Chest pain or discomfort
• Diagnosed pleural effusion from conditions like heart failure, pneumonia, cancer, or liver disease
• Recurrent pleural effusion needing ongoing management

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Blood tests and imaging studies (like chest X-rays or ultrasound) may be required.
• Patients should inform the healthcare provider about any medications, allergies, or existing medical conditions.

Procedure Description

1. The patient is positioned comfortably, usually sitting upright.
2. The skin over the insertion site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. Using imaging guidance, a thin needle is inserted into the pleural space to aspirate some fluid and confirm placement.
5. A catheter is then inserted through the needle into the pleural space.
6. Once correctly positioned, the needle is removed, leaving the catheter in place for ongoing drainage.
7. The catheter is secured and connected to a drainage system.
8. The site is covered with a sterile dressing.

Duration

The procedure typically takes about 30-60 minutes.

Setting

This procedure is usually performed in a hospital setting, either in an outpatient clinic, the radiology department, or a surgical center.

Personnel

• Interventional radiologist or pulmonologist
• Nurses
• Radiology technicians

Risks and Complications

• Infection at the insertion site
• Bleeding or hemothorax (blood in the pleural space)
• Pneumothorax (collapsed lung)
• Pain at the insertion site
• Allergic reactions to anesthesia

Benefits

• Immediate relief from symptoms like shortness of breath and chest discomfort
• Prevents the accumulation of fluid, reducing the need for repeated procedures
• Improved quality of life and lung function

Recovery

• Post-procedure monitoring for a few hours
• Instructions on how to care for the catheter site at home
• Possible restrictions on physical activities to prevent dislodging the catheter
• Follow-up appointments to assess fluid drainage and overall condition

Alternatives

• Repeated thoracentesis without indwelling catheter
• Pleurodesis (a procedure to adhere the lung to the chest wall, preventing fluid buildup)
• Medications to manage underlying conditions causing pleural effusion
• Surgery in more severe cases

Patient Experience

During the procedure, patients may feel pressure but should not feel pain due to local anesthesia. Post-procedure discomfort at the insertion site is common but can be managed with pain medications. Most patients experience significant symptom relief shortly after the procedure.