Eliana Muis

M. Harun Iskandar

Subdivisi Pulmonologi / Bagian Ilmu Kedokteran Respirasi

Fakultas Kedokteran Universitas Hasanuddin
Makassar

Definition
Pleurodesis is a medical procedure in which
the pleural space is artificially obliterated
Pleurodesis is a long-term symptomatic
therapy (paliative treatment) and is expected
to improve the patients quality of life, also
daily activities

Indication
Pleurodesis is performed to prevent
recurrence of pneumothorax
Pleurodesis is performed to prevent
recurrent pleural effusion

Contraindication
No absolute contraindication for pleurodesis
Contraindicated in negative pressure induced
effusion (worsening symptoms during pleural
evacuation) :
Endobronchial obstruction
Thick pleural peel with trapped lung

Methods
Chemical tetracycline, doxycycline,
bleomycin, povidone iodine, slurry talc
Surgical pleurectomy, thoracoscopic talc
pleurodesis
Radiotherapy radioactive gold, external
radiation

Chemical Pleurodesis
Chemicals such as bleomycin, tetracylcine,
povidone iodine, or a slurry of talc can be
introduced into the pleural space through a
chest drain.
The instilled chemicals cause irritation
between the parietal and the visceral layers of
the pleura which closes off the space between
them and prevents further fluid from
accumulating.

Chemical Pleurodesis
Povidone iodine is equally effective and safe
as talc, and may be preferred because of easy
availability and low cost.
Chemical pleurodesis is a painful procedure,
so patients are often premedicated with a
sedative and analgesics. A local anesthetic
may be instilled into the pleural space, or an
epidural catheter may be placed for
anesthesia.

Malignant pleural effusion

Massive pleural effusion

Special considerations
1. Are the symptoms (especially dyspnoea)
directly related to the effusion?
Thoracocentesis should relieve the patients
symptoms of dyspnoea
If dyspnoea is due to parenchymal involvement,
thoracocentesis will not reduce the symptoms

Special considerations
2. Is the effusion reccurent?
This is commonly thought to be an important
issue for consideration of pleurodesis
Some clinicials suggested that pleurodesis be
attempted sooner rather than later during the
course of the disease

Special considerations
3. Is the lung re-expandable?
The presence of a trapped lung should be
suspected by the finding of very low pleural
pressures as fluid is withdrawn during
thoracocentesis
It is recommended that measurement of pleural
fluid pH be used as a first approach to assess
multiple factors in evaluating a patient prior to
pleurodesis

Special considerations
4. What is the life expectancy?
Aggressive techniques, such as pleurodesis,
should not be attempted in patients whose
expected survival is short
Certain clinical parameters (e.g Karnofsky index)
can be of help in making decisions
Pleural fluid glucose and pH determinations are
very useful in selecting patients as candidates for
pleurodesis

Stages of pleurodesis
1. Installment of WSD
2. Pleurodesis

Identifikasi tempat dilakukan pemasangan WSD,

aseptik dan lokal anastetik

Insisi dg lebar 1-2 cm dan pelebaran klem

Hecting

Insersi WSD (menggunakan trocar 22/24/28)

Setelah cairan keluar dilakukan pengikatan

dengan benang yang telah dipersiapkan
sebelulmnya

Bila produksi cairan pleura minimal (<50 cc perhari)

Tindakan selanjutnya adalah pleurodesis

Technique of pleurodesis
Informed consent
Instillation with Lidocaine (5 amp of Lidocaine
+ 100 cc NaCl 0,9%)
The patients is moved in variety of positions
so that the anesthetic spread evenly in the
pleural cavity
Position: supine, prone, lateral, prostration,
etc

Technique of pleurodesis
The sclerosing agent then instilled (e.g.
bleomycin 15 mg (3 vial) + NaCl 0,9% 100 cc)
Then the patients is moved in variety of
positions so that the agent spread evenly in
the pleural cavity (position: supine, prone,
lateral, prostration, etc)
WSD clamped + 24 hours and then streamed
Prescribed analgetic

Monitoring after pleurodesis

CXR AP control
Vital signs
Daily monitor of chest tube drainage
Monitor of air leak
Change the bandage after 48 hr
Pain management
Spirometry (if needed)
Mobilization
Consider to remove the chest tube if the fluid <50 cc/
day or fluctuation on WSD is negative

Complications pleurodesis
Pain
Tachycardia, tachypneu, pneumonitis, respiratory
arrest (especially after insertion of slurry talc),
re-expansion lung oedem
Fever, due to pleuritis
Incomplete lung expansion & partially trapped lung
Drug reaction
Neurogenic shock