Ultrasound guided pleural tap or drain

Transcription

1 Patient information Whipps Cross University Hospital Ultrasound guided pleural tap or drain Department of Respiratory Medicine

2 Why do I need a Pleural tap or drain? n These are procedures to remove fluid or air from the space between the lungs and the chest wall. This space is called the pleural space or cavity. The procedure involves either a needle or thin tubing being inserted through the chest wall into the space under local anaesthetic. Normally, the pleural space is filled with a small amount of fluid (about four teaspoons). Some conditions such as heart failure, lung infections and tumours can cause more fluid to build up. When this happens it is called a pleural effusion. An air leak from the lung into the pleural space is called a pneumothorax. A lot of extra fluid or air can press on the lungs, making it hard to breathe. A pleural tap (or aspiration) is done to try and find the cause of a pleural effusion, or to remove enough fluid or air to help you to breathe more easily. A pleural (or chest) drain is done to remove a larger volume of fluid or air. You will be told by your clinic or ward doctor which procedure you will be having and then be referred to this department. 2

3 How are they carried out? Preparation The procedure will be completed by a specialist doctor in the CT Intervention Suite (at Junction 3 in the main hospital), or may be done on the ward if you are an inpatient. You will have the chance to ask any questions and will need to sign a consent form if you are happy to go ahead. You may be given a painkiller or sedation prior to the procedure. If you are given sedation, you will not be able to drive or sign any important documents for the rest of the day and you will need someone to take you home. For the procedure, you will either sit on the end of the bed with your head and arms resting on a pillow on a table in front, or lie on the bed with your arm above your head. The best site for the procedure is identified using an ultrasound scan machine. This scan is not invasive and will not hurt. The procedure is performed using an aseptic technique to minimise the risk of infection. Your skin is cleaned with an alcohol cleaner to kill any bacteria and a local anaesthetic is then injected to numb the area. This can sting temporarily but does not last for long. Pleural tap or Aspiration The doctor inserts a thin needle or narrow tube through the chest wall into the pleural space and any fluid or air is withdrawn. The needle or tube is then removed and a small dressing is placed where it was inserted. The risks are uncommon and include bleeding or a pneumothorax (see page 4, paragraph headed Risks of Procedure for details). If these occur, they can resolve spontaneously or be treated with a chest drain. 3

4 Pleural/Chest Drain A narrow tube (drain) is inserted and remains in place for 24 hours or more if the fluid or air needs to be drained over a longer period of time. If this is required, you will probably need to stay in hospital. Your clinic or ward doctor will let you know if this applies to you before you attend the appointment. A small cut is made in the anaesthetised area and the doctor gently opens up a path for the narrow tube or drain. It is normal to feel a sensation of pressure and tugging as the drain is gently eased into the chest. The drain is held in place with stitches and the exit site is covered with a waterproof dressing. The end of the tubing is connected to a drainage bottle, which acts as a collection chamber. Your drain will be monitored regularly. You may be asked to cough, or take a deep breath. This enables the nurse to ensure the drain is still functioning. You will be given regular pain relief while the drain is in place. Pain may inhibit your movement and breathing which may prolong the time your lung takes to expand, so it is important to report any pain and keep it under control. Risks of the procedure In most cases the insertion of a chest drain is a routine and safe procedure and most people find breathing is much easier once the chest drain is in place. However, like all medical procedures, chest drains can cause some problems. The risks are: Pneumothorax: where air collects in to the pleural space. This can resolve itself or may need treatment with a chest drain. Most people experience some discomfort from their chest drain, but painkilling medication can control this. Sometimes chest drains can become infected but this is uncommon. If you feel feverish or notice any increase in pain or redness around the chest drain inform your nurse or doctor. 4

5 Very rarely, during insertion, the chest drain may accidentally damage a blood vessel and cause serious bleeding. About 1 in 500 patients may develop significant bleeding during tube insertion. If this does happen it might require an operation to stop it. Chest drains sometimes fall out and need to be replaced. The drain may be stitched in place and is always covered with a firm dressing to help prevent this. You can reduce the likelihood of this happening by adhering to the suggestions in the next section Looking after your chest drain. Looking after your chest drain You can move and walk around with a chest drain but you must remember to carry the drainage bottle with you. Always carry the bottle below the level of your waist. If it is lifted above your waist level, fluid from the bottle may flow back into the pleural space. Whilst in bed keep the drainage bottle on the floor Do not pull on your chest drain or tangle it around your bed Do not swing the bottle by the tube Do not leave the ward unless you inform a nurse Try not to knock the bottle over If your chest is painful tell your nurse If you feel your tube may have moved or may be coming out tell your nurse Inform your nurse if you feel any increased shortness of breath 5

6 How to contact us and further information If you would like any further information about this procedure, or if any problems arise, you may telephone the Chest Clinic secretaries, Monday to Friday, between 9am and 5pm on extension 5016 or If you have any problems after hours or at the weekend, please contact your GP or attend Accident and Emergency. Large print and other languages For this leaflet in large print, please ring or For help interpreting this leaflet in other languages, please ring Reference: BH/PIN/091 Publication date: October 2012 All our patient information leaflets are reviewed every three years. 6