Autologous Blood Patch Treatment for Pneumothorax With a Persistent Air Leak

You have been given this leaflet because you have a pneumothorax with a persistent air leak.

This leaflet will describe what this and how it can be treated using an autologous blood patch.

What is pneumothorax?

A pneumothorax is also known as a collapsed lung. This means that air has leaked out from your lung in to your chest cavity and chest wall. This causes your lung to collapse down and peel away from the inside of your chest.

How is this normally treated?

You will have had a chest drain inserted. This is a flexible plastic tube, inserted through your chest wall into your chest cavity. This may have been connected to a suction port to try and help your lung to heal. Unfortunately, this has not been successful in healing your pneumothorax.

What is a persistent air leak?

A persistent air leak is a tear in the surface of your lung, which continues to leak air into your chest cavity. This stops your lung from re-inflating and repairing itself.

How does this happen?

This is normally caused by a small bleb or blister on the surface of your lung, which has burst and has not been able to heal.

The healing process may be slowed or impacted if you have an underlying lung condition, such as asthma or COPD (Chronic Obstructive Pulmonary Disease).

What is an autologous blood patch?

The word autologous means using your own tissue or fluid in a treatment or procedure.

An autologous blood patch is a procedure where blood is collected from one of your veins. This is then injected into your chest cavity through the chest drain that is already in place.

How might this help my pneumothorax?

It is not clear exactly how a blood patch works. It may help by doing a combination of the following: 

1. Clotting over the injured lung – After the blood is injected, it may clot over the injured area in the surface of your lung. Blood is more likely to clot here, due to the damaged and inflamed edges of the tear in the surface of the lung.
2. Causing inflammation – The blood may cause general inflammation inside your chest cavity. This inflammation causes the surfaces of your lung and the inside of your chest to become “sticky”. Your lung is then more likely to stick to the inside of the chest, which covers the injured area and lets the lung heal.

What other treatments could I have had?

Most patients with a pneumothorax who require a chest drain will heal without any other treatments. A small number of patients, such as yourself, will need other treatments. These can include:

1. Surgery – An operation can be done where a camera is inserted through your chest wall to find the injury on your lung. This is then repaired. This operation is ONLY suitable for patients who are fit enough to survive a general anaesthetic and the healing process after the operation.
2. Talc pleurodesis – This is a similar procedure to a blood patch. Instead of blood, talcum powder is injected into your chest. This causes inflammation inside the chest. This causes the lung and chest wall to stick together.

This can be a painful procedure, which has the risk of causing severe or life threatening inflammation inside your chest, although this is rare.

Even though these are possible alternative procedures, the team looking after you feel that your general health or your lung condition means they are not suitable for you.

They will discuss why they feel this is the case in more detail with you.

Where is this procedure done?

This procedure is normally done in the respiratory wards of North Tees Hospital. It will be done at your bedside. Occasionally, we may bring you to a different department in the hospital called “Lung Health”.

Can I have this done as an outpatient?

No. You will need to be monitored closely after the procedure. You will also continue to have the chest drain in until your lung heals.

What checks will I need before the procedure?

You will have the following checks before you have the blood patch performed:

1. Your pulse, blood pressure, blood oxygen level, breathing rate and temperature will be checked by a member of the Nursing team. These are referred to as your “vital signs”. This is to make sure that you are stable physically to have the procedure.
2. Blood tests – You will normally have your blood count and blood clotting checked in the 48 hours before the procedure. The team may do other blood tests to make sure there is no signs of infection and to make sure that your other organs are working normally.
3. X-ray or other types of scans – You will have had a chest X-ray, usually within 24 hours of the blood patch.

You may also have had a more detailed X-ray called a CT scan. This is done to make a 3-D picture of the inside of your chest. This helps the team to work out if there is any reason that the blood patch is less likely to work.

Will I need to stop or change any of my normal medicines before or after I have the procedure?

For most medicines, you can continue to take them, without any changes.

If you are taking blood thinners (also known as anticoagulants), then these are normally stopped before the test.

If there is a reason that these medicines cannot be stopped, even for a short time, your team will think about whether this procedure is right for you.

Will I need to sign anything before the procedure?

You will normally be asked to sign a consent form. This consent form confirms that:

• You have had the test explained to you
• You have had a chance to ask any questions
• You understand the risks and are willing to go ahead with the test.

Can I have any medicine to help calm my nerves before the procedure?

For most patients, this is not usually needed. However, if you are very nervous, it may be possible to have a small dose of a short-acting sedative before the procedure.

Can I have someone with me while the procedure is done?

Yes. If you want a family member, friend or another member of the ward team to support you during the procedure, this is usually fine.

Who will do the procedure?

The procedure will be performed by a trained Doctor, with the correct level of experience.

We are a teaching hospital and are responsible for training Doctors in skills they need to deliver healthcare in hospital medicine. We take great pride in this.

With this in mind, the procedure may be performed by a Doctor-in-training, under the supervision of a senior Doctor. A Doctor-in-training is a qualified Doctor, who is going through the training programmes to be a senior Doctor.

How is the procedure done?

The procedure is usually done in the following steps:

1. Chest drain – You have a chest drain inserted already. The team will extend the tube leading from your chest wall to the drain bottle, which sits by your bedside.
2. Getting the blood – One of the team members will take 50 – 150ml of blood from a vein in your arm or leg, with standard blood taking equipment.
3. Inserting the blood – The blood will be injected through a side port on your chest drain tube, into your chest. This will then be flushed with some additional water or saline (medical grade salt water).
4. Making sure the blood stays in your chest – The chest drain tube will be looped up on a drip stand so that the loop is above the level where the tube enters your chest.

This makes sure that the blood cannot drain back out of your chest, but it allows the air to continue to drain out of your chest. This loop can then be taken down after four hours.

How long does the procedure take?

This procedure can usually be completed in 10 to 15 minutes.

What are the risks of having this done?

This is a safe procedure and most patients will have no, or only mild side effects.

There are possible side effects of having this procedure. These include:

1. Failure of the procedure – The procedure may not be successful and your lung may not heal.
2. Infection – There is a small chance of an infection in your chest cavity.
3. Fever – Blood in your chest cavity can cause you to have a fever or high temperature.
4. Breathlessness – If the blood causes inflammation inside your chest, this can cause you to feel breathless.

There is limited information about potential long-term effects (this means effects that continue many years after the procedure).

There is a very small chance that the procedure could leave scarring at the edge of the lung or chest. There is a chance that this could lead to breathlessness many years after the procedure. However, this has not been found in any studies.

Will it hurt to have this procedure?

The blood is taken from your vein using a normal blood-taking needle. There is normally a small scratch as the needle is inserted, but after this, it usually is not painful.

The blood is inserted into your chest through the chest drain that is already in place. No new tubes are inserted. There is usually no pain or only mild pain as the blood settles inside your chest cavity.

If the blood causes inflammation inside your chest cavity, this can cause discomfort or pain. You would be prescribed painkillers to help your pain to settle.

Will this procedure definitely work?

We cannot give you a guarantee that this will definitely work, but studies show that this procedure is successful in nearly 9 out of 10 patients.³

How long will it take to work?

Before the procedure, it is not possible to predict whether the procedure will work or how long your lung will take to heal. In some patients, the lung has stopped leaking air within a few hours. If there has been no improvement within 48 hours, it is unlikely to work after this.

How will you know if this has worked?

The team that are caring for you will know that it has worked in two ways:

1. Your chest drain will stop bubbling air (provided it has not blocked for any reason).
2. Your chest X-ray will show that your lung is re-expanding into its normal position.

Will I need a blood transfusion to replace the blood that has been taken to do this?

No, the volume of blood that is taken is only approximately 100ml. Your body can cope with this and replace it without any problems.

Contact numbers

University Hospital of North Tees

Lung Health

Telephone: 01642 624270

Comments, concerns, compliments or complaints

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