Name of the Procedure:

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

Summary

This procedure involves the administration of a fibrinolytic agent through a chest tube to help break up and drain multiloculated effusions, which are pockets of fluid that have become trapped in the lung pleura.

Purpose

The procedure addresses pleural effusions that have formed within the chest cavity. The goal is to dissolve the fibrous material trapping the fluid, allowing it to be drained more effectively and improving lung function.

Indications

• Patients with multiloculated pleural effusions (fluid trapped in pockets in the pleural space).
• Symptoms such as difficulty breathing, chest pain, or persistent cough that don't respond to initial treatments.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Blood tests and imaging (like a chest X-ray or CT scan) may be required.
• Adjustments to medications, particularly blood thinners, may be necessary.

Procedure Description

1. The patient is positioned appropriately, often lying on their back or slightly to one side.
2. A local anesthetic may be administered to numb the area where the chest tube is inserted.
3. The chest tube, already positioned in the pleural space from a previous procedure, is used to instill the fibrinolytic agent.
4. The fibrinolytic agent is delivered through the tube to the effusion site to break down the fibrin networks.
5. The chest tube remains in place to allow fluid to drain out over time.
6. The chest tube and drainage system are monitored closely.

Duration

The procedure itself typically takes about 30 to 60 minutes. Monitoring may continue for several hours.

Setting

This procedure is generally performed in a hospital setting, either in a specialized procedure room or a patient’s room.

Personnel

• Pulmonologist or thoracic surgeon.
• Nurses specialized in respiratory or thoracic care.
• Radiologist (if imaging guidance is used).

Risks and Complications

• Infection at the insertion site.
• Bleeding.
• Pain or discomfort.
• Rare but serious complications can include damage to the lung or surrounding structures, and allergic reactions to the fibrinolytic agent.

Benefits

• Improved lung function due to the effective drainage of pleural fluid.
• Alleviation of symptoms like shortness of breath and chest pain.
• The patient may experience symptom relief within a few days following the procedure.

Recovery

• Patients might need to stay in the hospital for observation.
• Pain management with medications as needed.
• Follow-up imaging to ensure that the pleural effusion has resolved.
• Instructions on how to care for the chest tube site if it remains in place temporarily.

Alternatives

• Repeated thoracentesis (draining the fluid with a needle).
• Surgical intervention to remove or strip away fluid pockets (decortication).
• Each alternative may vary in invasiveness, effectiveness, and recovery time, as well as suitability depending on the patient’s condition.

Patient Experience

• Mild discomfort or pressure during the instillation of the fibrinolytic agent.
• Post-procedure, patients might feel some soreness at the chest tube site.
• Pain management strategies will be employed to ensure patient comfort.
• Breath easier and feel symptom relief as the fluid is effectively drained.