Mesothelioma pleurocentesis is a minimally invasive procedure that removes fluid buildup in the lungs. The procedure is also known as thoracentesis. It can alleviate some pleural mesothelioma symptoms, such as shortness of breath. Pleurocentesis may be performed as an outpatient procedure.

01. Definition

What Is Pleurocentesis?

Pleurocentesis is commonly known as thoracentesis. Pleurocentesis is a minimally invasive procedure that removes fluid from the pleural space. The pleural space (pleural cavity) is the space between the two layers of the pleura. The pleura is the double-layered membrane surrounding the lungs.

The pleural space typically holds a small amount of pleural fluid. Pleural fluid allows the lungs to expand and contract smoothly. However, disease or illness can increase the amount of pleural fluid, creating a condition called pleural effusion.

Pleural effusion can compress the lung, causing uncomfortable symptoms. Pleurocentesis drains the excess fluid responsible for causing such symptoms.

Note: Pleural effusion and pulmonary edema are not the same. In pulmonary edema, fluid collects inside the lungs. In pleural effusion, fluid collects between the layers of the membrane covering the lungs.

02. Pleurocentesis for Mesothelioma

How Does Pleurocentesis Treat Mesothelioma Symptoms?

Pleurocentesis treats one common mesothelioma symptom: pleural effusion.

Asbestos exposure causes malignant pleural mesothelioma (MPM). MPM can cause excessive fluid to collect in the pleural space. This fluid may take up space normally occupied by the lung. This can make it difficult for the lung to expand and contract. Mesothelioma patients with pleural effusion often experience difficulty breathing as a result.

Pleurocentesis addresses this issue by removing the excess fluid in the pleural space. The procedure provides temporary relief of pleural effusion symptoms. However, pleural effusion may recur in some patients.

In cases of recurrent pleural effusion, mesothelioma doctors may recommend pleurodesis. Pleurodesis collapses the pleural space in an effort to prevent fluid buildup.

03. Procedure

The Pleurocentesis Procedure

Doctors may administer pleurocentesis as an outpatient or inpatient procedure. The choice between outpatient and inpatient depends on the individual patient and their unique situation.

Pleurocentesis usually takes 10 to 15 minutes. However, the procedure may take longer if there is a lot of fluid in the pleural space.

How Much Fluid Can Be Removed During a Pleurocentesis (Thoracentesis)?

The amount of fluid removed during pleurocentesis varies from patient to patient. In some cases, the procedure may remove three liters of fluid or more from the pleural space.

The procedure may include the following steps:

  1. The patient may require oxygen during the procedure. If so, the patient may receive a nasal tube or face mask for oxygen.
  2. A health care provider will identify the area of the skin where the needle will go.
  3. A provider will clean the skin with an antimicrobial fluid.
  4. A health care provider will apply a sterile numbing medicine to the skin.
  5. The treatment team will wait for the skin to become numb. This means the pleurocentesis should not cause much, if any, pain.
  6. A health care provider will use a hollow needle to access the pleural space. The patient may feel some pressure where the needle enters the skin.
  7. Depending on the amount of fluid, the provider will use a syringe or a tube to drain the fluid.
  8. If necessary, a health care provider will replace the needle with a flexible tube (catheter) that stays in place. This will allow fluid to drain for a day or two.
  9. Once a sufficient amount of fluid has drained, a health care provider will remove the needle and/or tube. This fluid may be sent for biomarker analysis.
  10. The physician may also order imaging tests such as a chest X-ray or CT scan. These tests will check for complications from the procedure.

Pleurocentesis Recovery

During and directly following the procedure, the care team will monitor the patient’s vitals. This includes blood pressure, heart rate and breathing. Once a doctor clears them to leave, the patient can return home.

The patient will need to have someone drive them home. Depending on the patient’s occupation, they may also need to take a day or two off from work to recover.

The treating physician will provide guidelines regarding physical activity limitations after pleurocentesis. The care team will also provide a list of potentially serious side effects. These may include a high fever, chest pain and vomiting.

Pleurocentesis patients should contact their doctor with any concerns in the weeks immediately after the procedure.

04. Side Effects

Pleurocentesis Side Effects and Risks

According to experts, pleurocentesis is generally safe. It is uncommon for major complications to arise due to pleurocentesis. However, some patients do experience side effects during or after surgery.

Possible Side Effects of Pleurocentesis

  • Air in the pleural space
  • Bleeding
  • Collapsed lung (pneumothorax)
  • Coughing
  • Fainting
  • Infection
  • Pain or discomfort
  • Rarely, cancer seeding/metastasis (cancer cells spreading elsewhere along the incision site)
  • Rarely, injury to the liver or spleen

According to medical literature, some patient factors may increase the risk of pleurocentesis complications. For example, one study found underweight patients had a higher risk of a collapsed lung (pneumothorax). Underweight means body mass index (BMI) lower than 18 kg/m2. This is roughly equivalent to a weight less than 104 pounds for a 5’4″ person.

In another study, procedures requiring more than one needle stick had a higher rate of pneumothorax.

Physician factors may also affect the risk of pleurocentesis side effects. Using ultrasound to guide needle placement has been associated with fewer side effects. In one pleurocentesis study, ultrasound reduced the risk of pneumothorax by 19%. Ultrasound also reduced the average cost of treatment and the length of hospital stays.

05. Benefits

Benefits and Advantages of Pleurocentesis

Pleurocentesis can provide several benefits, including symptom relief. The following benefits have been reported for pleurocentesis:

  • Doctors can administer pleurocentesis as a palliative treatment.
  • Patients can undergo repeat pleurocentesis if necessary.
  • Patients experience reduced feelings of breathlessness (dyspnea) after pleurocentesis.
  • Pleurocentesis improves mental and physical quality of life for pleural effusion patients.

In one study, 30% of pleurocentesis patients had recurrent pleural effusion within 15 days of treatment. Thus, the repeatability of pleurocentesis is important.

If recurrent pleural effusion becomes particularly bothersome, a doctor may recommend pleurodesis. Pleurodesis may provide longer-term treatment of pleural effusion.

After pleurocentesis, patients may also consider additional treatment options. For instance, pleural mesothelioma patients with operable disease may undergo a pleurectomy/decortication (P/D). This surgical treatment aims to remove cancer cells by removing the pleura. In doing so, P/D may also prevent recurrence of pleural effusion.

06. Eligibility

Pleurocentesis Eligibility

Eligibility for pleurocentesis depends on several factors, including the patient’s overall health. It may be suitable for most pleural mesothelioma patients.

However, certain factors may make pleurocentesis inappropriate for an individual. These factors include:

  • Active infection
  • Certain bleeding conditions
  • Unusual chest wall anatomy

A patient’s eligibility for pleurocentesis is best determined by a mesothelioma specialist. A mesothelioma doctor can explain an individual’s eligibility for pleurocentesis and other treatment options. They can develop a personalized treatment plan for the patient’s unique needs.