Pleurodesis is a medical procedure in which the pleural space is artificially obliterated.It involves the adhesion of the two pleurae.
Pleurodesis is performed to prevent recurrence of pneumothorax or recurrent pleural effusion. It can be done chemically or surgically. It is generally avoided in patients with cystic fibrosis, if possible, because lung transplantation becomes more difficult following this procedure. Previous pneumothorax with or without pleurodesis is not a contraindication to subsequent lung transplantation.
Chemicals such as bleomycin, tetracycline (e.g., minocycline), povidone-iodine, or a slurry of talc can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating Pharmacy-prepared chemicals for pleurodesis should be clearly labeled “NOT FOR IV ADMINISTRATION” to avoid potentially fatal wrong-site medication errors.
Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.
Chemical pleurodesis is a painful procedure, and so patients are often premedicated with a sedative and analgesics. A local anesthetic may be instilled into the pleural space, or an epidural catheter may be placed for anesthesia.