Name of the Procedure:

Instillation(s) via chest tube/catheter for fibrinolysis (e.g., fibrinolytic agent for breakup of multiloculated effusion); initial day. Common name(s): Fibrinolysis via chest tube.

Summary

This procedure involves administering a fibrinolytic agent through a chest tube or catheter inserted into the pleural cavity to dissolve fibrous tissues, which can help clear loculated pleural effusions (pockets of fluid in the chest).

Purpose

The procedure is designed to treat multiloculated pleural effusions, which are fluid accumulations with fibrous partitions within the chest cavity. The goal is to dissolve these partitions, allowing the fluid to be drained more effectively.

Indications

• Persistent or complicated pleural effusions that do not resolve with standard drainage.
• Conditions such as post-surgical effusions, parapneumonic effusions, or empyema.
• Patients with fluid collections in the pleural space complicated by fibrous tissues.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be required.
• Diagnostic imaging (e.g., chest X-ray or CT scan) is often performed beforehand to assess the effusion.

Procedure Description

1. The patient is usually positioned upright or at a slight incline.
2. Local anesthesia or sedation may be administered to ensure comfort.
3. A sterile chest tube or catheter is inserted into the pleural space.
4. A fibrinolytic agent is instilled through the tube or catheter.
5. The agent is left in place for a specified period to dissolve the fibrous tissues.
6. Fluid is then drained from the pleural space.
7. The procedure may be repeated over several days, as needed.

Tools: Sterile chest tube or catheter, fibrinolytic agent, local anesthetics, imaging guidance equipment.

Duration

Typically takes about 30 to 60 minutes for the instillation, though the drainage can continue for several hours or days.

Setting

Usually performed in a hospital setting, often in a radiology department or procedure room.

Personnel

• Interventional radiologist or thoracic surgeon.
• Nurses and possibly an anesthesiologist or a respiratory therapist.

Risks and Complications

• Potential risks include infection, bleeding, or pneumothorax (collapsed lung).
• Rare complications might include allergic reactions to the fibrinolytic agent or damage to surrounding tissues.
• Management involves monitoring for symptoms and providing supportive care as necessary.

Benefits

• Relief from symptoms such as chest pain and difficulty breathing.
• Improved lung function and easier breathing.
• Effusion reduction and better overall lung health typically noticed within a few days.

Recovery

• Patients will be monitored closely following the procedure.
• Post-procedure instructions may include taking antibiotics, pain management, and follow-up imaging.
• Recovery time varies but most patients can resume normal activities within a few days with some restrictions.

Alternatives

• Conventional chest tube drainage without fibrinolytic agents.
• Surgical options such as video-assisted thoracoscopic surgery (VATS) or open decortication.
• The pros and cons include more invasive procedures versus longer recovery times.

Patient Experience

• Mild discomfort or pain during and after the procedure, managed with pain relief medications.
• Sensations related to chest tube placement, such as pressure or a pulling sensation.
• Post-procedure, patients often feel immediate improvement in breathing as fluid is drained.