1.How to deal with pleural effusion?
Can a small amount of pleural effusion be absorbed by itself?
After effective treatment of the primary disease and no new effusion continues to be produced, there is hope that the existing small amount of pleural effusion can be absorbed by itself. However, there are some special cases that require a comprehensive decision by the clinician to assist in the management.
What is the amount of fluid that needs to be absorbed with medication? What medications are usually available?
There are no medications specifically for pleural effusions, and the medications used in general are mainly for the primary disease. Except for some small amounts of effusion that do not require special treatment, thoracentesis and closed chest drainage are the main means for doctors to deal with pleural effusions.
What is the amount of pleural fluid that needs to be aspirated?
There is no absolute quantitative threshold for a physician to determine whether a pleural fluid needs to be aspirated. It needs to be combined with the patient’s symptoms, etiology and ancillary tests. For example, if the patient is an infected purulent pleural fluid, even if the volume of fluid is not too large, the physician may be more aggressive in using puncture and aspiration treatment because effective drainage is the basic principle in the treatment of acute abscess chest.
Recurrent pleural effusion after pleural aspiration, is it necessary to aspirate again in this case?
In most cases, patients with recurrent pleural effusion present with symptoms do need to have the fluid pumped again in addition to active treatment of the primary disease. It is important to emphasize that whether or not to re-evacuate is a matter for the physician’s comprehensive judgment based on the patient’s condition, and no generalization can be made here.
Will pleural effusion recur after it has disappeared?
As we mentioned earlier, the production of pleural effusion is closely related to the primary disease, therefore, with the change of the disease, the performance of pleural effusion may also exist repeatedly.
2.What are the precautions for pleural fluid extraction
What are the methods of pleural fluid extraction? Can it be done on an outpatient basis?
In layman’s terms, pleural fluid extraction is when a doctor, under local anesthesia, uses a steel needle to puncture into the chest cavity and draw out the fluid to achieve the purpose of specimen sampling and treatment. For some patients who need repeated pumping, a thin tube can be placed in the chest, which is normally closed and pumped through a syringe when needed, thus avoiding the trouble of repeated punctures and some risks. In hospitals where conditions are favorable, especially in some hospitals, special puncture centers have been built in outpatient clinics so that the operation of thoracentesis and aspiration can be performed in the outpatient clinic, usually requiring the patient to rest and observe for a short time after the puncture before leaving.
Is it painful to have a chest aspiration? What complications can occur?
During the puncture operation, the doctor will first administer local anesthesia to reduce the pain felt by the patient during the puncture. After local anesthesia, for most patients, there will be no significant pain. Although it is an operation that can be performed on an outpatient basis, thoracentesis aspiration is still an invasive treatment with its specific risks of complications, such as bleeding at the puncture site, pneumothorax, visceral injury, and in severe cases, such as diplopia pulmonary edema and pleural reaction, etc. Doctors will also inform patients and their families of these risks before the puncture. I once assisted a respiratory physician to resuscitate a patient who had a pleural reaction during puncture. Such complications are often difficult to predict and are not something that physicians would like to have, but the patient was safe and sound after resuscitation, but the family was unusually agitated and rushed much on this issue. Although thoracentesis seems to be a small operation, its risk possibility needs to be understood by the family.
Is it normal to have blood in the chest water after pleural effusion puncture?
If the pleural effusion is not bloody and there is a small amount of blood mixed in the pleural fluid after puncture, it is usually caused by a small amount of bleeding from the wound site and is a common occurrence. If the bleeding does not continue to occur or increase, there is no need to worry too much.
How much pleural fluid should be drawn at a time?
For diagnostic aspiration, 50-100ml is sufficient each time. For therapeutic aspiration, for patients with a large amount of fluid, the first time is usually no more than 800ml, and each time thereafter is no more than 1000ml.
What symptoms will occur if too much pleural fluid is pumped at one time? How to deal with it?
For patients with prolonged pleural effusion, if too much fluid is withdrawn at one time, the previously compressed lung tissue will rapidly reopen, resulting in reopened pulmonary edema, causing varying degrees of hypoxemia and hypotension, mostly occurring immediately or within one hour after the fluid is withdrawn, mainly manifesting as severe cough, dyspnea, chest pain, irritability, etc., followed by coughing up large amounts of white or pink foamy sputum, which may cause shock in severe cases. Treatment measures include correction of hypoxemia and hemodynamic disorders, cardioplegia, diuresis, hormone use, etc. if necessary, and severe cases may require ventilator mechanical ventilation.
For whom is closed thoracic drainage indicated?
Closed thoracic drainage is a surgical procedure that thoracic surgeons need to be proficient in to drain gas and fluid (common effusions as well as bloody and purulent effusions) from the pleural cavity for therapeutic purposes. The need for drain placement requires a specific judgment by the thoracic surgeon based on the patient’s condition. The general indications include: moderate to massive pneumothorax, traumatic moderate to massive hemothorax, persistent pleural effusion, abscess chest, and after open chest or thoracoscopic surgery.
What are the precautions to prevent infection?
Strict asepsis is the primary means of prevention, and patients are usually supplemented with antibiotics to prevent infection. However, in cases where the pleural fluid is already infectious in nature, such as abscess chest, the chance of wound infection tends to be higher in such patients.
What other complications may occur and how can they be prevented?
Closed chest drainage is already a surgical procedure that is more invasive than puncture and often requires greater discomfort for the patient during and after the procedure. Common complications of closed chest drainage include: pneumothorax, hemothorax, adjacent organ damage, poor drainage, and infection (incision, chest cavity). Closed thoracic drainage is a closed system, if the integrity of the wound-tube system is disrupted and there is air leakage into the chest, it can cause pneumothorax. We have met patients who turned over in the middle of the night in bed and accidentally tore the drainage tube off, resulting in pneumothorax, which required repositioning the drainage tube; bleeding from the wound or within the chest may cause hemothorax, so it is important to closely observe the color and shape of the drainage fluid and deal with the bleeding situation promptly In some patients with trauma or spontaneous hemothorax, the pleural effusion itself is a blood collection, which needs to be distinguished; some patients with complex pleural effusion (e.g., encapsulated effusion, viscous effusion) or poor placement of drainage tubes may lead to the final drainage effect being affected, which often requires adjustment of drainage tubes or repositioning; infection is a risk of complications encountered in surgical procedures, and strict aseptic Strict asepsis is the primary means of prevention, and patients are usually supplemented with antibiotics to prevent infection. However, in cases where the pleural fluid is already infectious in nature, such as abscess chest, the chances of wound infection tend to be higher in such patients.