Types of fluids
Four types of fluids can accumulate in the pleural space:
- Serous fluid (hydrothorax)
- Blood (haemothorax)
- Chyle (chylothorax)
- Pus (pyothorax or empyema)
Treatment depends on the underlying cause of the pleural effusion.
Therapeutic aspiration may be sufficient; larger effusions may require insertion of an intercostal drain (either pigtail or surgical). When managing these chest tubes, it is important to make sure the chest tubes do not become occluded or clogged. A clogged chest tube in the setting of continued production of fluid will result in residual fluid left behind when the chest tube is removed. This fluid can lead to complications such as hypoxia due to lung collapse from the fluid, or fibrothorax, later, when the space scars down. Repeated effusions may require chemical (talc, bleomycin, tetracycline/doxycycline), or surgical pleurodesis, in which the two pleural surfaces are scarred to each other so that no fluid can accumulate between them. This is a surgical procedure that involves inserting a chest tube, then either mechanically abrading the pleura or inserting the chemicals to induce a scar. This requires the chest tube to stay in until the fluid drainage stops. This can take days to weeks and can require prolonged hospitalizations. If the chest tube becomes clogged, fluid will be left behind and the pleurodesis will fail.
Pleurodesis fails in as many as 30% of cases. An alternative is to place a PleurX Pleural Catheter or Aspira Drainage Catheter. This is a 15Fr chest tube with a one-way valve. Each day the patient or care givers connect it to a simple vacuum tube and remove from 600 cc to 1000 cc of fluid. This can be repeated daily. When not in use, the tube is capped. This allows patients to be outside the hospital. For patients with malignant pleural effusions, it allows them to continue chemotherapy, if indicated. Generally the tube is in for about 30 days and then it is removed when the space undergoes a spontaneous pleurodesis.
Nursing Care Plan for Pleura Effusion
Ineffective airway clearance related to weakness and poor cough effort.
- Demonstrate effective airway clearance and proved with respiratory status, gas exchange and ventilation are not dangerous :
- Having a patent airway
- Removing the secretion effectively.
- Having a rhythm and respiratory frequency in the normal range.
- Having a lung function within normal limits.
- Show that adequate gas exchange is characterized by :
- Easy to breathe
- No anxiety, cyanosis and dyspnea.
- Saturation of O2 in the normal range
- Chest X-ray within the expected range.
- Assess and document :
- The effectiveness of oxygen and other treatments.
- The effectiveness of treatment.
- Trends in arterial blood gases.
- Anterior and posterior chest auscultated to determine the decrease or absence of ventilation and the presence of sound barriers.
- Suction airway
- Determine the need for sucking oral / tracheal.
- Monitor the status of oxygen and hemodynamic status and cardiac rhythm before, during and after exploitation.
- Maintain adequate hydration to reduce the viscosity of secretions.
- Explain the use of support equipment properly, such as oxygen, suction equipment lenders.
- Inform patients and families that smoking is an activity that is prohibited in the treatment room.
- Instruct patients about cough and deep breathing techniques to facilitate the release of secretion.
- Negotiate with respiratory therapists as needed.
- Tell your doctor about the results of an abnormal blood gas analysis.
- Assist in the provision of aerosols. Nebulizer and other pulmonary care according to institutional policies and protocols.
- Encourage physical activity to improve the movement of secretions.
- If the patient is unable to perform ambulation, the location of the patient sleeping position changed every 2 hours.
- Inform patients before starting the procedure to reduce anxiety and increase self-control.