Standard Operating Procedures

Pleurodesis
Equipment list

Inj Morphine/Tramal/Diazepam (if required to alleviate anxiety)

Prescribed sclerosant, usually talc 4g

Lignocaine solution: (3mg/kg required, maximum 250mg)

50 ml syringe

Povidone Iodine solution

2 x 10cc Syringes

100ml of 0.9% saline

Sterile dressing pack

Chest drain clamp

Procedure:

1. Explain and discuss the procedure to the patient and take consent.
2. Record baseline observations of temperature, pulse, respiratory rate and
oxygen saturations.
3. Pre-medicate with Inj Diazepam/Opioid if required. Give it time to
become effective.
4. Prepare Talc Slurry (if not already prepared by pharmacy) by dissolving
3-5g of talc in 50ml of Normal Saline.
5. Clamp the chest tube, open its junction with underwater seal.
6. Give Inj Lignocaine 2% about 10ml (200mg) not more than 250mg
through 50ml Feeding syringe into the chest tube, diluted in about 10 –
20 ml if Normal Saline. Wait for about 10 min for anesthetic to take
effect.
7. Administer Talc Slurry through the chest tube using the feeding syringe.
An additional 20 – 25 ml of Normal Saline may be given to flush the
slurry into the pleural cavity.
8. Elevate the tube higher than the wound, and clamp it again.

High Dependency Unit, Gulab Devi Hospital Lahore

 Standard Operating Procedures

9. After one hour, unclamp the tube and allow free drainage of fluid through
the underwater seal. Tube may be flushed or suctioned to ensure fluid is
draining.
10. If draining volume is less than 150ml in next 24 to 48 hours, extubate. If
>250ml, consider repeat pleurodesis.
11. Get a fresh X-Ray Chest to confirm apposition of Pleural surfaces.

Precautions:

1. Confirm apposition of pleural surfaces and complete lung expansion

before pleurodesis. Ensure fluid drainage <150ml/day.
2. Explain the procedure with necessary details to the patient. Also inform
the possible pyrexia/pain after the procedure.
3. Pre-medicate with adequate analgesic, as the procedure is painful.
4. Ensure tube patency and position before procedure.
5. DO NOT GIVE ANTI INFLAMMATORY AGENTS UPTO 48 HRS AFTER
PLEURODESIS. This may lead to failure.
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High Dependency Unit, Gulab Devi Hospital Lahore