Case Series Report: The Novel Use of a Long Drain Line Post Intraoperative Talc Pleurodesis

Abstract

First described in 1917, pleurodesis the fusing of visceral and parietal pleura, has a wide range of clinical applications. Talc pleurodesis is now widely used in the management of recurrent pneumothorax or malignant effusion, with a validated safety profile. As a result of chemical irritation to the pleural lining inflammation, adhesion and obliteration of the potential space results. Typically the procedure is completed at the bedside after chest drain insertion. However, the diagnosis is not clear operative pleural biopsy which is often required to be followed by on table talc insufflation. At this stage, once the port is closed and suction drainage commenced, large volumes of talc are lost from the thoracic space into the drain. In theory this reduces remaining intra-thoracic talc and thus potential for successful pleurodesis. Traditionally post procedure the drain is frequently removed within the first 24 hour period leaving the expanding lung at risk of developing an air leak. Described in this article is a technique we now use on all suitable talc pleurodesis patients. It employs a lengthened and raised drain line, allowing immediate ongoing suction drainage whilst minimising intrathoracic talc loss.