Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc for recurrent or persistent pneumothorax)
CPT4 code
Name of the Procedure:
Instillation via chest tube/catheter, agent for pleurodesis (commonly known as Talc Pleurodesis for recurrent or persistent pneumothorax)
Summary
Talc pleurodesis is a medical procedure where a chemical agent, typically a sterile talc powder, is introduced into the pleural space via a chest tube or catheter to create inflammation and adhere the lung to the chest wall. This helps prevent the recurrence of a collapsed lung (pneumothorax).
Purpose
The procedure aims to treat recurrent or persistent pneumothorax (collapsed lung) that does not resolve on its own or continues to come back. The goal is to create a permanent adhesion between the lung and chest wall to eliminate the space where a pneumothorax could reoccur.
Indications
- Recurrent pneumothorax
- Persistent pneumothorax that doesn't resolve with standard treatments
- Pleural effusion management when traditional drainage is not sufficient
- Patient deemed a poor candidate for surgical correction due to underlying health conditions
Preparation
- Fasting for a specific number of hours prior to the procedure may be required.
- Blood tests and imaging, such as chest X-rays or CT scans, to assess lung and pleural space.
- Medication adjustments, particularly if the patient is on blood thinners.
Procedure Description
- The patient is positioned appropriately and a chest tube or catheter is inserted into the pleural space.
- Local anesthesia is typically administered to numb the area. Sedation or general anesthesia may be used as needed.
- The sterile talc powder is then instilled through the tube into the pleural space.
- The substance causes an inflammatory reaction that leads to fibrosis and adhesion of the two pleurae.
- The chest tube may remain in place for a few days to ensure complete lung adherence and drainage of any excess fluid.
Duration
The instillation process itself usually takes about 30 to 60 minutes. Overall hospital stay may be longer if a chest tube remains in place for monitoring.
Setting
The procedure is typically performed in a hospital setting, often in an operating room or a designated procedure room.
Personnel
- Pulmonologist or thoracic surgeon
- Surgical nurses
- Anesthesiologist or sedation nurse, if sedation is required
Risks and Complications
- Pain or discomfort during and after the procedure
- Infection at the site of the chest tube insertion
- Fever or chills
- Inflammation of nearby organs
- Rarely, severe respiratory distress or failure
Benefits
- Reduces the likelihood of recurrent pneumothorax
- Can be an effective long-term solution for recurrent lung collapse
- Generally well-tolerated with a high success rate
Recovery
- Patients may require a hospital stay of several days for monitoring.
- Pain management typically involves NSAIDs or prescribed pain medication.
- Regular follow-up appointments to monitor lung health and ensure proper healing.
Alternatives
- Surgical intervention such as pleurectomy or VATS (Video-Assisted Thoracoscopic Surgery)
- Conservative management with repeated needle aspiration or chest tube drainage
- Observation in cases where pneumothorax resolves on its own
Patient Experience
During the procedure, patients may feel discomfort or pain from the chest tube insertion. Post-procedure, they might experience soreness and some discomfort, which is manageable with pain medications. Breathing may be easier almost immediately, although full recovery and adherence can take several days. Regular updates from the healthcare team will help manage expectations and ensure a smooth recovery process.