Pleural Effusion

WHAT YOU SHOULD KNOW:

The pleura (PLOOR-ah) are thin layers of tissue that form a two-layered lining around the lungs. One layer of the pleura rests directly on the lungs. The other layer rests on the chest wall. Between these layers, there is a small amount of fluid, called pleural (PLOO-ral) fluid. This fluid helps your lungs move easily while you breathe. Sometimes extra fluid collects in the space between the two pleural layers. This is called pleural effusion (e-FU-zhun). Many things may cause a pleural effusion, such as lung infections (in-FECK-shuns), heart failure, or cancer. The first step in treating pleural effusion is to treat the cause, if it is known. You may need to have the extra fluid removed. More treatments may be needed if your pleural effusion causes problems or keeps coming back.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

A pleural effusion may cause or worsen a lung infection, such as pneumonia (noo-MOH-nyah). The extra fluid may get infected and form a pocket of pus, which is called empyema (em-peye-EE-ma). You may have other problems, such as a collapsed lung. The problems you may have depend on what is causing your pleural effusion. Talk to your caregiver about any concerns you may have about your illness or treatment.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Rest:

Keep the head of your bed raised to help you breathe easier. You can also raise your head and shoulders up on pillows or rest in a reclining chair. If you feel short of breath, let caregivers know right away.

Tests:

Tests help caregivers find out what is causing your illness and how your body is handling it. Other tests are used to help caregivers plan your treatment. The tests you need depend on what may be causing your pleural effusion and other health problems you may have. You may need one or more of the following tests:

• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Sputum sample: Sputum (mucus from your lungs) is collected in a cup when you cough. The sample is sent to a lab to be tested for the germ that is causing your illness. It can also help your caregiver choose the best medicine to treat the infection.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Ultrasound: An ultrasound is a simple test that allows caregivers to see inside of your chest. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. An ultrasound may help caregivers find extra pleural fluid or the cause of it.
  
  
• CT scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of the inside of your chest. You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish or have other allergies.
  
  
• Biopsy: A biopsy (BEYE-op-see) is a procedure to remove a small piece of tissue from your lung or pleural lining. The tissue will be sent to the lab for tests. A biopsy may be taken with a needle, or through a small cut in your chest wall. If you need a biopsy, ask your caregiver for more information about the kind of biopsy you will have.
  
  
• Thoracentesis: A thoracentesis (thohr-ah-sen-TEE-sis) is a procedure to take fluid out of your chest. You are given numbing medicine, and then a needle is put between two of your ribs. The extra pleural fluid is sucked out through the needle. This fluid may be sent to the lab for tests. These tests may help caregivers find out what is causing your pleural effusion and the best way to treat it. You may breathe easier when the fluid is removed. You may need a thoracentesis more than once.
  
  
• Bronchoscopy: This is a procedure to look inside your airway and learn the cause of your airway or lung condition. A bronchoscope (thin tube with a light) is inserted into your mouth and moved down your throat to your airway. You may be given medicine to numb your throat and help you relax during the procedure. Tissue and fluid may be collected from your airway or lungs to be tested.
  
  
• Thoracoscopy or VATS: A thoracoscopy (thor-ah-KOS-kah-pee) lets caregivers see inside your chest and perform tests or treatments. It is sometimes called video-assisted thoracic (thoh-RAS-ik) surgery, or VATS. Caregivers use a special scope to do a VATS or thoracoscopy procedure. A scope is a long tube with a light and small camera on the end. The scope is put into one or more incisions (cuts) in your chest wall. You will have special medicine, called anesthesia (an-es-THEE-zah), to make you comfortable during the surgery or procedure. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep.

Treatment options:

Treatment of pleural effusion can be very different from person to person. Your treatment may depend on what is causing your pleural effusion. Treatment may also depend on how often your pleural effusion comes back, your symptoms, and your overall health. You may have some of the following treatments alone or together.

• Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.
  
  
• Deep breathing and coughing: Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up sputum (mucus) from your lungs. You can deep breathe and cough on your own, or with the help of an incentive spirometer.
  
  
  • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue and throw it away. Take 10 deep breaths in a row every hour that you are awake, even during the night. Remember to follow each deep breath with a cough.
    
    
  • An incentive spirometer can help you take deeper breaths. Put the plastic piece into your mouth and take a steady, deep breath in. Hold your breath as long as you can, and then exhale (breathe out). Use your incentive spirometer 10 times every hour that you are awake, even during the night.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pleurodesis: Pleurodesis (ploo-ROD-e-sis) is a procedure that causes the two pleural layers to stick together. This may decrease your risk of having a pleural effusion in the future. During a pleurodesis, the extra fluid is drained from your pleural effusion with a chest tube. Then, a medicine or chemical is put into the tube. This causes the pleural layers to become irritated and stick together. Once the pleural layers stick together, there is no room for extra fluid to collect in between the layers. Pleurodesis may also be done during a thoracoscopy.
  
  
• Pleuroperitoneal shunt: A pleuroperitoneal (ploor-oh-per-i-toh-NEE-al) shunt allows extra pleural fluid to drain into your abdomen. The fluid is then absorbed back into your body. A shunt is a thin, flexible tube that is placed underneath your skin. One end is in your pleural space, and the other is in your abdomen.
  
  
• Thoracotomy or other surgeries: Some conditions (such as cancer) may cause your pleural effusion to come back often. If so, you may need surgery to correct the cause of your pleural effusion or to keep it from coming back. You may also need surgery to fix a problem caused by your pleural effusion. Examples include surgery to remove scarring around the lung, or to remove part of the pleural lining itself. A surgery where the chest wall is opened is called a thoracotomy (thohr-ah-KOT-ah-mee). Ask your caregiver for more information about any surgery or procedure that you may need.

Medicines:

The medicines you need may depend on what is causing your pleural effusion. For example, you may need cancer drugs if your pleural effusion is caused by a tumor (growth). You may need medicine put into your chest if the fluid is hard to drain or has blood clots. This is usually done through a chest tube. Other medicines you may need include:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Cough medicine: You may need a cough medicine to help loosen phlegm in your lungs and make it easier to cough up. This type of cough medicine is called an expectorant. Drink plenty of water if you are taking an expectorant type of cough medicine. Another type of cough medicine that decreases your urge to cough is called a cough suppressant. A cough suppressant may help if a dry cough is causing you to have pain or trouble resting.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Nonsteroidal anti-inflammatory medicine: This family of medicine is also called "NSAIDS". Nonsteroidal (non-ster-OID-al) anti-inflammatory (an-tee-in-FLAM-ah-tohr-ee) medicine may help decrease pain and inflammation (swelling). It is also used to decrease a high body temperature (fever). This medicine can cause stomach bleeding or kidney problems in certain people.
  
  
• Steroids: Steroid (STER-oid) medicine may be given to decrease inflammation around your lungs or to help you breathe easier.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Pleural Effusion (Inpatient Care)