Pleural effusion pathway

The pleural effusion pathway has been created for patients with a pleural effusion to explain your patient journey. It has been developed to include national and locally agreed patient-centred evidence.

This leaflet will help explain what a pleural effusion is and what you can expect after a diagnosis has been made.

If you have any questions or feedback on this leaflet, please contact the AEC Unit Mon–Fri, 8am–8pm and 11am–2pm at weekends. Alternatively you can contact the ward you were discharged from.

For more specific advice you can ask your team or contact the Respiratory Nurse Mon–Fri, 9am–5pm via the hospital switchboard 020 8560 2121.

What is a pleural effusion?

A pleural effusion is a condition affecting the lining of the lung (pleura). Your pleura is a large, thin sheet of tissue that wraps around your lungs and lines the inside of your chest wall. Between the two layers is a very thin space that is normally filled with a small amount of fluid.

Occasionally this pleural space can fill with air, fluid, infection, pus and/or blood. When it is filled with fluid it is called pleural effusion. There are many conditions that can cause this to happen.

How will I be diagnosed?

Your doctor will take a history, do a clinical examination and investigations. This includes taking bloods and an X-ray. Normally a chest X-ray is sufficient to diagnose a pleural effusion.

We may also perform an aspiration or pleural tap using ultrasound guidance. This involves a small needle which is inserted into the pleural space to take a small amount of fluid to help with diagnosis. It can also be used as a form of treatment and is done by numbing the skin using local anasethetic. In some cases, a computer tomography (CT or CAT scan) may assist in diagnosis.

How will I be treated?

Having a pleural effusion does not necessarily mean you need to be admitted to hospital. Depending on the clinical situation you may be discharged and have follow up. This is usually with the Ambulatory Emergency 

 

Care unit (AEC in Outpatients 1) or Respiratory (lung specialist) clinic.

Your medical team will always try and treat the underlying cause of the pleural effusion. For example, an infection will be treated with antibiotics.

We may also need to aspirate larger volumes for symptom relief (which can be done at the same time as diagnostic tap, as explained above). Sometimes we use a chest drain to help drain a large effusion, which will be explained below.

What is a chest drain?

  • In a few cases we will use a chest drain to help drain a pleural effusion
  • A chest drain is a sterile plastic tube that allows drainage of the pleural space
  • The doctor will discuss the benefits of having a drain and provide alternatives
  • You will have an injection of local anaesthetic to make the area where the drain will be inserted numb—this might sting
  • The drain is inserted between the ribs in the anaesthetised area—it will be stitched in place and a dressing will be applied
  • The drain will be connected to a tube and drainage bottle containing water—the water acts as a one-way seal to allow the fluid to drain out and not go back into your chest
  • It is important that the bottle must be kept below the level of your chest at all times to prevent the fluid returning to the chest
  • The whole procedure usually takes 20–30 minutes
  • You will be prescribed regular pain relief as it is vital to keep your pain well controlled to enable you to take deep breaths and avoid infection—ask the nurse if you require more pain relief

What happens next?

For patients with a chest drain

If a chest drain is inserted you will be offered painkillers and a chest x-Ray is taken to confirm the position.

The drain will remain in place for as long as you need it. This varies from case to case and your team will keep you informed. Your drain will be removed before you go home.

For all patients on the pleural effusion pathway

On discharge you will be reviewed with the results by a specialist in the respiratory (lung) outpatient clinic. They will send an appointment in 2–6 weeks depending on how urgent your condition is. We aim to limit hospital admissions while continuing your individual care in the community.

It can take up to a month to fully recover from a significant infection. You should gradually increase your activity to return to normal level by 4–6 weeks. Ask your team or GP for more specific advice.

References and more information

Contact information

Ambulatory Emergency Care (AEC)
Outpatients 1
West Middlesex University Hospital
Twickenham Road
Isleworth
Middlesex
TW7 6AF

T: 020 8321 5966
E: 

Contributors
George Vasilopoulos