Pleura effusion

[EZSZ]

I have pleura effusion scheduled. Freaking out. Is it painful?

What's the criteria to drain all at once vs. Leaving a drain?

Thank you

[Bestbird]

I had pleural effusion in 2011. It sounds scary but can be quite treatable! Below from my book, "The Insider's Guide to Metastatic Breast Cancer," which is also available as a complimentary .pdf, is a list of options to drain the fluid. For more information, visit insidersguidembc.com

I hope it goes away over the next month or two!

For patients who have pleural effusion, there are three methods of draining the fluid to provide relief:

Indwelling (Pleurx or Aspira) Catheter: This is the surgical insertion, under general anesthesia, of a small tube placed temporarily into the pleural space that allows the patient or his/her family member to drain the fluid into a bottle as needed. Patients with an indwelling catheter are fully mobile and are not “attached” to the draining bottle except when draining the fluid. Once there is no more drainage at all, the catheter is removed either in the doctor’s office or an outpatient procedure. Overall, indwelling catheters seem to help prevent the fluid from building up again, provided that the patient’s systemic treatment is working. The Pleurx catheter works via suction, and the newer gentler model is the Aspira catheter, which is a bit less uncomfortable because uses gravity instead of suction for draining.

Pleurodesis (sometimes referred to as a “talc procedure”) is a process in which substances, such as talc, are used to try to get the edge of the lung to stick to the chest wall to decrease the chance of the fluid returning. Although this procedure seems to help prevent the fluid from building up again (provided that systemic treatment is working) it can be painful and usually requires a brief hospital stay. Some patients have reported discomfort months and even years after the procedure. In rare cases, the procedure may fail altogether, rendering it impossible to drain the fluid thereafter because it becomes trapped in a honeycomb of many small pockets (called “loculations”). Of all options for draining malignant pleural effusion, this appears to be the most risk-prone.

Thoracentesis (sometimes referred to as “tapping”) is an outpatient procedure that involves placing one needle per required side into the pleural space. Although local anesthesia is administered, this procedure can be uncomfortable and may cause scarring if repeated over time. The procedure also does not hinder fluid buildup again. These tips may make the procedure less uncomfortable: 1) Request a numbing agent before the needle is inserted to feel more comfortable after the procedure. 2) Request that the fluid to be withdrawn slowly in order to avoid low blood pressure or a “fainting” feeling afterwards. 3) Lean forward with a soft pillow supporting your head and upper torso while the draining is underway via your back.

[Iwasborntodothis in reply to Bestbird]

Best bird you are the best! We are all so grateful for your detailed answers to our questions. 🙏

[Bestbird in reply to Iwasborntodothis]

Hoping it helps, and that you begin to improve very soon!

[EZSZ in reply to Bestbird]

Thank you for the detailed reply. Very helpful.

[bankusboysmom]

I had thoracentsis (sp?) done. It was uncomfortable but not painful. Doc drained a liter if fluid from my right lung. Best thing I’ve done. No longer short of breath. When needed again, I’d do it in a heartbeat.Melinda

[EZSZ in reply to bankusboysmom]

Thanks Melinda. That's reassuring. No need for catheter?

Dully

[bankusboysmom in reply to EZSZ]

None, was at outpatients clinic maybe two hours, was a little sore, took a nap, still a little sore the next day but that was it.

[Hidden]

Hi, I had a pleural effusion drained in 2017. I was nervous about it too, but it wasn't that bad. They administered something to numb the area while they were inserting the needle, so I don't remember it as being very painful. And the procedure itself was pretty quick. They drained a liter from my right lung, and did not leave a catheter in. It did fill back up with fluid, but my medical oncologist felt that the treatment would dry it up, and it did. I was on Letrozole, Lupron, and Ibrance.

[EZSZ in reply to Hidden]

Highly appreciate the response, encouraging. I assume from your response that you are HER2 negative. I'm HER2 positive and still on my first round of chemotherapy, so quite a newbie.

[Hidden in reply to EZSZ]

Yes, I am HER2 negative.

[Gingerann1]

Actually, your not having a pleural effusion. That is actually the condition that you have. What they are going to do is treat the pleural effusion (basically fluid on the lung). I had a thoracentestis to drain the fluid. Another poster provided a great explanation of the several ways they are treated. My procedure went very well, removing 600 ml of fluid. Subsequent scans show that there has not been an increase in fluid. I would only have to have a drain if that changes as it isn’t good to keep having this procedure although some have had it multiple times. My guess is that you’re having a thoracentesis. As long as they drain the fluid slowly ( mine was done too quickly and I was about to faint so they pulled everything so I could lay down and had to start over once I stabilized). I would do it again. Not as bad as it sounds. They inject lidocaine in as they proceed toward the lung so I didn’t really feel much. Best to you as you navigate this journey we’re all on.

[EZSZ in reply to Gingerann1]

Thank you. Appreciate the candid sharing.

[hurricaneheather]

when the bc mets to the right pleura and pleural effusion dx were presented in July 2015, i chose an "aggressive" route. rather than solely have thoracentesis, the body underwent procedure for talc pleurodesis, as well as flexible bronchoscopy, VATS, excision of pleural tumors, and wedge resection. due to this, i was in the hospital for a few days. the most discomfort was when the tube draining the fluid was removed; i think everyone on the hospital floor heard me scream "f***!" the ribcage was tender and uncomfortable after leaving the hospital, also. the body is a miracle and healed well; there is collateral damage and discomfort that is manageable, for me. grateful the body has not needed any further procedure for the aforementioned.

[EZSZ in reply to hurricaneheather]

Wow, thanks for sharing. I like your positiveness. Mine shrank somewhat with Chemo, so I'm hoping for a simple, one time thoracenthesis . I have bad memories from both mastectomies, mostly the drain removal.

Would you know what is the criteria doctors use to decide on treatment? Whether it's a one time procedure or a catheter?

[hurricaneheather in reply to EZSZ]

i do not know the criteria. i know the choice was the "right" one for this body. i vaguely recall i was told that if the talc did not adhere, then there could be the possibility of another pleural effusion which could entail a drain and/or thoracenthesis. blessed that there was, and still is, talc adhesion.

[EZSZ in reply to hurricaneheather]

Very happy for you. I feel for each and every one of us, wish each and every one a long, pain free life.We are lucky to live in an era when there are efficient treatments available to us.

Thank you. Bless you.

[hurricaneheather in reply to EZSZ]

thank you. we are fortunate to have the option of efficient treatments; and stage four still needs more. i, too, wish all with a dx to live with ease, for a long time. keeping you in my thoughts, particularly for the procedure. may you be happy.

[WordNerdSharron]

Hi EZSZ, I've had several thoracenteses. Other than some uncomfortable coughing and snarfing as the lung begins to expand again, I've had no trouble at all. This Wednesday I'm having a PleurX catheter installed because my pleural fluid has cancer cells in it, and we need to get that stuff out. I've also had five or six taps since my diagnosis. At some point, determined by your care team, they may want to look at a catheter. Why? Because evidently your body will begin to segment the effusions into individual pockets (loculations), and that makes it more difficult to treat.

It's supposed to be a temporary thing (they've told me best estimate is 2-4 months). I wanted to have a pleuradesis to fuse my pleura to my lung with talc spray, but my lung is not fully inflating, so this is the best option and may accomplish the same thing. It seems my effusion is coming from my liver involvement. Bestbird's answer below is great!

[EZSZ in reply to WordNerdSharron]

Well, thank you for your detailed reply which, incidentally, reassured and encouraged me. A catheter was mentioned, but decisions will be made at the day of procedure, based on the X-ray results.

Question: how do you find out if there are cancer cells in the fluid, during the procedure or is it sent to a laboratory and you wait for the results?

Do you have to take antibiotics if a catheter is installed?

For the records, my liver is clean, thankfully.

Thanks again,

Dully

[WordNerdSharron in reply to EZSZ]

Hi, Dully. When they aspirate the pleural fluid they generally reserve some for testing--if your physician orders it. It generally takes a couple of days to a week to get results where I live.

I am told that you don't take antibiotics with a catheter unless there is a need. I like sailing and kayaking, so if I fall in the bay the doctor said he would likely prescribe a round of antibiotics to ensure no trouble. I'm betting I get some IV antibiotics during the installation tomorrow, but I don't know.

I am so glad your liver is clean! That is a real blessing. Good luck!

[EZSZ in reply to WordNerdSharron]

Good luck to you as well, my dear. You've been truly instrumental for me. I'll be thinking about you tomorrow 🤞

[CincinnatiExperience]

Greetings,

I am so glad you turned to this list, as you are getting some terrific advice. I am adding mine to the pile.

I had a pleural effusion in May of 2019. It took weeks to build up, but wow was it a terrible trip. I went into the hospital, not knowing what to expect. When they finally found the pleural effusion (I guess through Xrays), they decided to get some of the fluid out immediately to provide me with relief, and then schedule the catheter insertion for later in the week.

The Thoracentesis was not pailful at all. In fact, they had a trainee doc do it for practice. They took an awful out of fluid out as I sat on the edge of the bed leaning forward with my arms and head resting on a pillow. That was done on a Sunday. The analyzed the fluid and found cancer cells. In fact, that was how I found out I had MBC. On the Thursday, they did the very quick surgical procedure to insert the cathetar, bascially under my ribs on the right side. (As an aside---I got a kick out of the PleurX box--it looked like a wedding gift!)

A home health nurse came a taught us how to do the draining. It was daily at first, then cut back eventually to weekly, and finally nothing was coming out. Even after that, it took WEEKS to convince my surgeon to take out the catheter. He wanted to be really sure the fluid creation was over (plus it was July-September, and I think vacations were getting in the way!) I really wanted that thing out! They finally did it in the office and the surgeon did it himself (accidentally spilled drops of blood on the wall--the nurse wanted to throttle him!) It is momentary pain, but you will be so happy to get rid of the thing, you won't care.

Make sure you have someone who can help you with the drainage, or ask for a home health nurse to help. It takes practice to get it right, and you need four hands to do it!

Good luck!

Anne (in Cincinnati)

[EZSZ in reply to CincinnatiExperience]

Hello Anne from Cincinnati. What a waty to find our, not that there is an easy way. So I've already had two mastectomies, which means I've felt the pain.

Thanks for sharing the story, it did help to put me at ease. Like most people, I don't want to physically suffer and do suffer anxiety before every treatment.

I'm finishing my 6th cycle of chemo & antibodies a day before (13 chemo's in all) so my condition is resolving slowly.

I do hope that you are well now, and thank you for sharing your experience in details.

Dully