Thoracentesis for pleural effusion

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honeybunny

Well-known member
Joined
Jun 20, 2015
Messages
1,034
Location
Outside Houston, Texas.
I'm scheduled for thoracentesis to drain pleural fluid. I have a good idea about what to expect, but if anyone has undergone this procedure I'd appreciate if you'd share your story. I am at 4 weeks post op and the fluid buildup has gotten progressively worse. My cardio expects me to lose 2-3 lbs from the treatment. My biggest concern is preventing it from occurring again.
 
When I had valve surgery my roommate was there for a week for something like this, but they were able to fix him with some drugs over a week stay. I asked alot about how to prevent this and so did he. There really isn't any way other than don't lift more than your told to and use the pillow. They said they don't see many people return with problems that weren't due to one of those factors.

Basically he had bypass surgery 2 months before and for the past month was getting worse to the point he couldn't walk 40 feet without being too winded to continue. so when he met with his surgeon for a checkup they admitted him saying they would try and fix with drugs and if they couldn't they'd have to tap him. They told him the tap insertion itself wasn't painful really but that the needle to freeze would be bad and that it would be way better for him if the drugs worked.

Was fixing your problem with drugs ruled out?
 
Interesting, Fundy. My cardio did not mention drugs though I read online that drugs were a treatment for pleural effusion as are diuretics. I specifically asked the cardio whether I should take the Lasix that I got when I was discharged and he said no, that I should take it only if my legs started to swell from water retention. Now, I have a lot of fluid according to the echo and x-ray. Like your roommate I can't walk very far without sitting down. So perhaps draining is considered the best way to get rid of it all. I'll ask when I go in on Monday. Thanks for the feedback.
 
Sorry to hear that you are dealing with this. I had pleural effusions after my surgery. The surgeon was going to do the thoracentesis as well. After he looked at my echo, he decided to up my lasix and I was on it for a good 3 or 4 weeks. I am not sure when they decide to go that route over lasix. Thinking of you and do hope that you feel better soon.
 
I think lasix is used more if the fluid is because your body is retaining it generally. I had to be readmitted a couple of months on with pleural effusions , mainly because my lungs didn't fully re-expand ( not enough walking and breathing exercises!) and I also had a late lung infection which was difficult to shift and needed lots of antibiotics. The first time I had a drain inserted for several days. It got rid of a lot of the fluid, but there was still some left when it was removed. Unfortunately I didn't manage to clear the rest naturally, and had to have a diagnostic thoracentesis.
I have to say my experience of the drain and its insertion was very painful, so much so that I dreaded the thoracentesis needle, but it was nothing like as bad. Even with the lidocaine it hurt though ( the pleura are very sensitive) and I really recommend getting plenty of painrelief lined up, and indeed having some preparatory morphine first. You may find sedation is available, since it seems in the USA they use sedation a lot more for things like TEE and colonoscopy. I must admit if I needed a drain again I would beg for sedation!
 
Thanks for the heads up Northernlights. My procedure is supposed to be done as an outpatient though I've read articles about the draining being done over multiple days. I'll ask about sedation but for now I think all I'll have is a local. What you said about Lasix appears to match my cardio' opinion. Thanks.
 
Northernlights;n859988 said:
I think lasix is used more if the fluid is because your body is retaining it generallyI had to be readmitted a couple of months on with pleural effusions , mainly because my lungs didn't fully re-expand ( not enough walking and breathing exercises!)

That's an interesting perspective from your cardio. In my case, i was having trouble breathing, had a collapsed lower lobe and pleural effusion on both lungs. He still opted to up my dosage of lasix. My body wasn't retaining fluid as the swelling in my ankles had come down. Perhaps, different doctors with different protocols???
 
Update for future reference. 1.7 liters drained from the left lung. Procedure relatively painless. Took less than 10 minutes. I coughed like crazy afterward, so much so that the radiologist considered keeping me overnight (it was 4:30 pm). X-Ray showed some fluid had gotten into my lung during the procedure. I was told this is not uncommon. I think it also had something to do with the lung reexpanding.

Coughing subsided enough for me to go home and I was told it would clear up with n an hour. After I stood up I got very lightheaded and could hardly walk but went home anyway. Felt terrible once I got there. I think either my blood sugar or BP was low; I'd not eaten anything that day and wasn't hungry. I sat up in the recliner all night, still coughing. Slept maybe an hour. Woke about 4:30 feeling good much better and am pretty much at 100% today, two days later. For the first time in 3 weeks I can walk without stopping to take a deep breath. This is week 5 post surgery and I feel I'm finally on the mend.
 
honeybunny;n860087 said:
For the first time in 3 weeks I can walk without stopping to take a deep breath. This is week 5 post surgery and I feel I'm finally on the mend.

Yahoo! As we always remind folks, sometimes it takes a while to get on track, but almost all of us have good outcomes once we pass that "certain point." We all heal at different rates and in different ways, but you will do just fine.
 
One more update, again for future reference. I had a second thoracentesis done on Friday. (see my post on SuperBob's Throwdown of 11/23/15 for background: http://www.valvereplacement.org/forums/forum/throwdowns/860543-staying-the-course-11-23-2015)

This one was done by a pulmonologist. I described the extreme coughing and night-long discomfort I'd had back on 11/2. He said the radiologist drained too much fluid. So this time, when I began coughing, the doctor told me to `) suppress the cough and 2) take shallow breaths as my lung expanded. Then he stopped after draining 900 cc.

BIG difference in outcome. I was able to drive myself home; the first time I needed a wheelchair to go from my living room to the bathroom. And I slept fine instead of sitting up all night as I had before.

So, if you need this procedure performed, query the doctor/radiologist/whomever as to how it will be done, particularly questioning the need to remove all fluid in one shot. Of course it was tough going through it again, but the previous discomfort was horrible.

Also, the pulmonologist diagnosed me with
post pericardiotomy pleural effusion, possibly from a "trapped" lung, which may require surgery to correct. Meanwhile I am on steroids and antibiotics. At least we are moving toward getting it resolved.
 
honeybunny It looks like you posted an update here just in time for me! I'm 10 days post-op and feel great. The surgeon's PA told me last Friday that my chest x-rays were the best she has seen in a long time. The doctor ordered a last minute echo, but the PA said the surgeon said I was doing so well, I'm released.

Fast forward a few hours when we were about 2 hours into our 6+ hour drive from Los Angeles, and the PA called me to ask, "How far away are you?" Uh, I don't like that question. What's going on? She said the echo showed fluid around my heart. They called in a prescription for 0.6 mg of colchicine, taken orally once per day. They also were insistent that I have another echo Monday (today) or Tuesday) but absolutely no later). I texted my cardiologist to let her know what was going on, and she said to increase the dose to twice per day.

I just had that additional echo today, and the cardiologist sees fluid but is not (yet) concerned about it, especially since I'm asymptomatic. She did not have the echo done last Friday in LA, though, so she can't compare to see if the issue is better, worse, or the same. She ordered another echo for next week, so we'll see things look then.
 
I'm wondering if you have pericardial effusion or pericarditis, which is different from what I have. I've seen posts about pericarditis since I've been a member so perhaps do a search on that term.

Getting that phone call must have been disconcerting if not downright frightening. Sounds to me like your cardio is on top of things. Unfortunately there must be so much time between tests in order to determine changes, and the wait can be frustrating.

You might want to start a separate thread on your condition to get more feedback and to keep us posted on your progress. Sending positive thoughts your way.
 
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Yes, I do have pericarditis causing a pericardial effusion. Perhaps I didn't read this entire thread closely enough and research your condition compared to mine, but the similarities I perceived were (1) fluid building up somewhere and (2) you having it drained (as I may also need it drained).

I definitely wasn't trying to hijack the thread and will definitely start another one if I have any questions about my issue specifically.
 
Oh, no Billy...I wasn't trying to imply that you hijacked this thread at all. I suggested a separate post only in hopes you would get more responses that way that would address your concerns. When I come here I peruse the titles to determine which to take a closer look at. I didn't want your issues overlooked because it was "buried" in this post.

Sorry for the confusion and if you don't start a separate thread by all means post here with updates. I care.
 
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No worries, I understood what you were suggesting! I'm not necessarily looking for responses because I don't really have any questions the doctor's haven't answered (yet).
 

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