Information for patients and families on drainage of pleural

effusions.
What is a pleural effusion?
The lungs are covered by a membrane or lining, called the pleura, which has an inner layer
and an outer layer. The inner layer covers the lungs. The outer layer lines the rib cage and
diaphragm, which is a sheet of muscle that separates the chest from the abdomen.
The pleura produces a fluid which acts as a lubricant that helps you to breathe easily,
allowing the lungs to move in and out smoothly. Sometimes too much of this fluid can build up
between the two layers of the pleura: this is called a pl eural effusion.



A pleural effusion


Signs and symptoms
The build-up of fluid presses on the lung, making it difficult for the lung to expand fully. In
some situations part or all of the lung will collapse. This can make you increasingly
breathless, not only when you are exerted, but when you are at rest as well. You may also get
some chest pain and a cough.



Drainage of a pleural effusion
The treatment of a pleural effusion can involve draining it to relieve the symptoms.
The drain is usually inserted by a doctor. You will be asked to sit either on a chair or on the
edge of the bed and then helped to lean forward over a table with a pillow to bend on so that
your back is exposed. The doctor will decide where to insert the drain usually in the side of
the chest. The skin over the area where the drain is to be inserted is cleaned with an
antiseptic solution to prevent the area from becoming infected. The doctor then gives you an
injection of local anaesthetic to prevent the procedure from being painful.
When the area has been anaesthetised the doctor makes a very small cut in the chest and
inserts a needle with a tube called a cannula. The cannula is attached to a tube and drainage
bag or bottle. The fluid drains out of the chest and collects inside the bag or bottle. The fluid
that drains may be bloodstained. You will usually need to stay in hospital for a couple of days
if there is a large amount of fluid. If there is only a small amount of fluid, the cannula is
removed immediately after the fluid has been drained off and the area is covered with a
dressing. Otherwise, the cannula will be held in place with a small stitch.
When the local anaesthetic wears off, you may have some pain or discomfort. Let the doctor
or nurse know if you have any pain, as painkillers can be prescribed to help.
Once the drainage has slowed down and the doctors think that most of the fluid has drained,
you will have a chest x-ray to see how well your lung has re-expanded. If it has, the drain will
be removed.
In some situations it may be possible to have your pleural effusion drained while you are at
home using a catheter that is very similar to a chest drain. The catheter will be put in while
you are in the hospital, where it will be attached to a suction bottle that will gently suck out
some of the fluid. It is then clamped off and covered with a dressing. You can then go home.
A district nurse will visit to re-attach the suction bottle to your catheter and drain off some
more fluid. This is repeated over the next few days, as many times as necessary to drain off
all the fluid. Draining the fluid from time to time in this way helps to encourage the lung to re-
inflate and the layers of the pleura to seal together.
Your specialist nurse will teach you, or your carers, how to look after the catheter and suction
bottle when you are at home. Once the fluid has stopped draining, you will go back to the
hospital to have the catheter removed.
Additional information
Usually the fluid will be drained off fairly slowly, as a sudden release of pressure in the chest can
cause a drop in blood pressure. A litre (2 pints) of fluid may be drained safely as soon as the drain
has been inserted. After this, drainage should be done more slowly. Your blood pressure will be
checked during the procedure. You should let your doctor or nurse know if you feel dizzy, sick or
light-headed.
As the fluid comes off and the lungs expand it is not unusual to cough.
The chest drain can become blocked, although this is rare. It can sometimes be cleared by
changing your position or sitting upright. Occasionally the drain may need to be replaced.
The drain can become infected. You will have your temperature checked for any sign that you are
developing an infection.

Is this procedure painful?
You may feel a stinging sensation temporarily when the local anaesthetic (numbing injection) is
injected.
You may also feel discomfort and pressure during the procedure. It may help to take some slow
deep breaths and try to relax during this time.
If you find the drainage-tube causes discomfort, try changing its position slightly.
If your drainage tube is attached to a bottle, you will be able to walk about with it. It is important to
be careful with the bottle, and it should not be raised above the level of the chest, as the fluid could
go back into your lungs. The nurses may clamp the drainage tube for you before you walk around.
Consent
We want every patient to be fully informed about the risks and benefits of a procedure
or treatment. Before you have the procedure the doctor will ask for your consent
(permission) for the procedure to be carried out. Please make sure that you understand
the risks and benefits of the procedure and that it has been explained to you in the
detail you need.

What are the risks with this procedure?


The doctor performing the procedure will discuss the risks and benefits with you.
As with any invasive procedure, there are small risks of bleeding and infection. These may be
increased if you are at risk for bleeding and infection due to your disease or treatment.
Swelling or soreness can occur at the site.
Shortness of breath or a collapsed lung may develop after the procedure.
In rare instances, injury may occur from the surgical procedure.
Very rarely, drainage of a pleural effusion can cause a drop in blood pressure and loss of
consciousness.
Precautions are taken to protect you from these risks as much as possible.



CMD LUNG MDT RFH
Patient information programme 2008
www.royalfree.nhs.uk