Common pleurodesis exam questions for medical finals, OSCEs and MRCP PACES
Question 1.
What should you consent the patient for in pleurodesis?
- Consent the patient for:
- Generic risks
- Bleeding, infection, pain, damage to surrounding structures
- Failure. Even in optimal conditions chemical pleurodesis is only successful in 80% of cases and rarely are “optimal conditions” achieved
- Specific risks
- Fever
- Acute respiratory distress syndrome (ARDS) – risk less than 1%
- Generic risks
Question 2.
What analgesia should be used for pleurodesis?
- Paracetamol and a weak opiod such as codeine may be sufficient – oramorph can also be used
- Further analgesia may be required but do not use NSAIDS as these can inhibit the inflammatory response within the pleural cavity which is needed for successful pleurodesis
Question 3.
How do you mix talc for pleurodesis?
- Shake vial to loosen talc then add 40ml of normal saline to 4g talc (using a syringe and needle directly into the talc vial (leave the bung in the bottle).
- Shake well to mix into talc slurry. Remove the bung and using a large syringe +/- plastic quill (no needle) instil into pleural space via the ICD. Keep solution moving continually and do not delay as the slurry will solidify quickly. Flush drain after instillation and clamp for 1 hour.
- Tip: It is very difficult to dissolve the talc and once the slurry is made so do not stop moving the syringe or the talc will precipitate out.