Letters to the Editor: Letters & Announcements
To the Editor:
Management of chronic recurrent intrapleural effusions after orthotopic liver transplantation is difficult. Frequent fluid evacuation with a chest drain or pigtail catheter is often painful and can provoke pulmonary edema. In our 68-yr-old patient a total effusion volume of 9 L had been tapped requiring 6 procedures over 8 months.
When chest radiograph review confirmed recurrence of the pleural effusion, with complete opacity of the right hemithorax and mediastinal shift away from this side, a 16-gauge epidural catheter was introduced via a 14-gauge Venflon plastic cannula inserted through the eighth intercostal space in the posterior axillary line. The catheter was shortened to 25-cm length with 10 cm left in the pleural space. A bacterial filter was attached. Over the next 12 h 1500 mL of effusion was aspirated in increments using a 50-mL syringe. A chest radiograph then showed a 50% reduction in the size of the pleural effusion but with persistent atelectasis of the right lung. The catheter was removed because patient was coughing and required oxygen supplementation for 2 h. Ten days later, the same procedure was repeated and a further 2500 mL was aspirated over 36 h, after which a chest radiograph confirmed complete lung re-expansion with no residual pleural effusion.
The use of a flexible epidural catheter in this way offers comfort and the ability to aspirate slowly, thus avoiding sudden physiological changes. The patient was pain-free throughout and preferred this method over previous aspiration techniques. The major disadvantage was the additional use of nursing staff time. In the future, education of the relatives and their involvement in fluid aspiration could be considered.
Zorica Jankovic, MD, PhD
Dusica Stamenkovic, MD, PhD
Wafaa Abdel-Hadi, MD
St. James’s University Hospital