Talc Pleurodesis

What is talc pleurodesis?

A talc pleurodesis is a procedure where a medical form of talcum powder is introduced into the space between your lung and chest wall. This talcum powder causes irritation and inflammation which causes the lung edge to stick to the inside of the chest wall.

Why am I being asked to have a talc pleurodesis?

You have been asked to have this as part of your treatment of a pleural effusion.

Very rarely, it is also used for treatment of a pneumothorax if other treatments are not possible.

What are these conditions?

Pleural Effusion

A pleural effusion is also known as “fluid on the lung”. Normally, the lining of your lung sticks to the inside of your chest and is lubricated by a thin rim of fluid. Occasionally too much fluid is produced, or it can’t be absorbed normally. This causes the fluid to collect between the edge of the lung and the inside wall of the chest.

Pneumothorax

A pneumothorax is also known as a collapsed lung. This happens when air leaks out of the surface of the lung and causes it to fall away from the inside of the chest.

The space where the fluid or air collects is called the pleural cavity.

How does a talc pleurodesis treat these conditions?

As mentioned, the talcum powder irritates the inside lining of the chest and causes it to become inflamed. The lung edge then sticks to the inside of your chest. This gets rid of the space that the fluid or air has collected in.

Where will I have this procedure?

Before the procedure you can eat and drink normally. You will also be asked to sign a consent form. The procedure is performed by a qualified doctor trained in this procedure.

You will have an X-ray and possibly an ultrasound (a scan performed using jelly, similar to the type of scan pregnant women have of their stomach) of your chest before the procedure.

This is to make sure all of the air or fluid has gone. If the lung has not managed to fully inflate and touch the inside of your chest wall, we may not be able to do the procedure.

• You may be given a small dose of liquid morphine to drink 30 to 60 minutes before the procedure.

• Local anaesthetic will be injected into your chest through the tube; this helps to make the inside lining of your chest less sensitive and you more comfortable during the procedure.

• A small amount of sterile medical talcum powder is then dissolved and injected through the tube into your chest.
• If you have a chest tube in hospital, it is then closed for 2 hours to allow the talcum powder to thoroughly move around the lining of your chest, after this time it is reopened

• If you have an IPC tube, it is closed but district nurses will visit daily for the next three days to drain fluid.

A talc pleurodesis may also be done during a test called a medical thoracoscopy. This is a procedure where a camera is inserted into your chest between your ribs to look at and investigate the inside lining of your chest. If your doctors are planning to also potentially do a talc pleurodesis during this procedure, they will discuss this with you beforehand.

How long does the procedure take?

The procedure usually takes only 15 to 20 minutes. The majority of the time is in the preparing the different medicines and talcum powder. If it is done in the outpatient clinic (Lung Health clinic in North Tees Hospital) you will be monitored for approximately an hour before you go home.

After the procedure, the chest tube normally stays in for at least 24 to 48 hours to allow any excess fluid to drain out. Once the doctors are happy, they will remove the tube.

If you have an IPC tube, this will stay in for longer. Your team will tell you when they think your tube can come out.

What are the risks or side effects of the procedure?

Chest pain

Some patients do experience chest pain during and after the procedure. As mentioned, you will be offered painkillers before the procedure. We will also prescribe painkillers regularly and as required after the procedure. It is important to us for you to be as comfortable as possible after the procedure.

Fever

It is common for patients to develop a fever or high temperature after this procedure. This is due to the inflammation chemicals released by your body in response to the talcum powder. We will give you medicine to help settle your temperature down. The high temperature may come and go for up to 2 or 3 days after the procedure.

Breathlessness

The lung itself does become inflamed after the procedure. This causes some patients to become breathless. This is usually mild and settles after a few days. In a small number of patients, it can be very severe or even fatal (extremely rare: less than 1 in 1000 patients who have the procedure).

Infection

There is a small chance of infection either at the site the tube is inserted into your chest, or in your chest cavity. The risk is small, about 1 or 2 in 100 patients will have this problem. It normally settles with antibiotics, however, it may mean you have to come back into hospital or stay longer.

How successful is the procedure likely to be?

The procedure is successful in 7 out of 10 patients and stops all or at least some of the fluid or air from re-accumulating.

What happens if the fluid or air comes back after a pleurodesis?

If the fluid or air does return, then there are things which we can do. This will depend on your wishes, but could be affected by your level of fitness. These may include:

• Pleural aspiration: Fluid is removed by inserting needle between the ribs. This can be done quickly and can relieve any symptoms.  It is normally used in patients in whom the fluid re-accumulates very slowly, who are frail or who don’t wish any other procedures.

• A further talc pleurodesis: It’s possible to do the same procedure again although it is less likely to be successful.

• An in dwelling pleural catheter: This is for those patients who first had a temporary chest drain.

• Surgery: Very rarely, we may ask a chest surgeon to consider a procedure to try and stop the air or fluid coming back.

Will I need any follow up?

You will normally be seen again in clinic by the team to check how successful the procedure has been. This may mean having more chest X-rays or ultrasound tests of your chest.

Contact numbers

Lung Health
Telephone: 01642 624270

Department of Respiratory Medicine
Monday to Friday
09:00am-05:00pm
Telephone: 01642 624936

Emergency Department
24 hours a day, 7 days a week
Telephone: 01642 382899

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1220
Date for Review: 28/08/2023