What Is Talc Pleurodesis?

Exposure to asbestos can cause many painful and debilitating health problems, including issues related to the lining of the lungs and the pleural space. These problems can lead to labored breathing, chest pain, and persistent cough. One treatment that may be recommended to a patient who is experiencing serious or repeated problems with the pleural space is talc pleurodesis.

What Is Pleurodesis?

Broken down, pleuro- means the lining of the lung and -desis means to bind. Pleurodesis is a medical procedure performed to prevent pleural effusion or pneumothorax. Pleural effusion is a gathering of liquid in the space between the lung and the chest cavity, or the pleura.

Pleural effusion is a condition that can apply pressure to the lungs and make it difficult to breathe. Pneumothorax is the medical term for a collapsed lung. It occurs when too much air gets into the space between your lung and the chest wall.

If you are at risk of pleural effusion or pneumothorax, your doctor may recommend talc pleurodesis. This procedure removes the pleural space by binding the lung to the chest wall. Eliminating this space can effectively prevent related health issues.

What Does Talc Pleurodesis Mean?

Pleurodesis can be done in two different ways: abrasion or a chemical irritant. The surgeon will either use a mechanical procedure, such as abrasion or partial pleurectomy, to close the space, or a chemical irritant to adhere the lung to the wall of the chest, sealing up the space in-between. Both work by causing irritation.

Talc pleurodesis installs talc in the pleural space to intentionally cause inflammation and fibrosis – closing up the space between the lungs and the chest wall. During this procedure, a surgeon will typically spray a mixture of talc and saline through a tube into the chest area that surrounds the lungs. It may also be applied in powder form.

How Is a Talc Pleurodesis Done?

If you elect to undergo talc pleurodesis, your doctor will first drain any fluid that is currently in your pleural space. You will need a chest x-ray to confirm that your lung has fully re-expanded. On the day of your procedure, once you have signed the consent form, expect the following steps:

You will be given an oral morphine solution and a local anesthetic inserted into a drain in your chest to help control pain. The anesthetic in the drain will numb the lining of the lung.
The doctor will add the talc-and-saline mixture into the drain slowly.
The doctor will turn the drain tap off and keep it closed for one hour to allow the talc to do its job. During this time, you can request additional painkillers, if necessary.
Your doctor will ensure that the drain is working properly and does not leak. During the procedure, you will be monitored by the nursing staff in case of any complications.
The doctor will open the drain tap and allow the liquid to drain out.
You will be kept overnight in the hospital. The next day, if your drain is showing minimal fluid output, it will be removed. Otherwise, you may have to stay for an additional day.

Unless there is a medical reason for you to remain in the hospital, you will be released once the drain has been removed. Most patients are released within 24 to 48 hours. Then, you will schedule a follow-up appointment with your doctor to see how effective the talc pleurodesis has been.

Why Do They Put Talc in Lungs?

During talc pleurodesis, the goal of administering talc to the lungs is to cause an inflammatory reaction in the pleura (the tissue that envelops the lungs). If the procedure succeeds, the irritation will be enough to close off the pleural space and prevent it from filling up with fluid in the future. Talc is used because it is the most effective sclerosant (injectable irritant) available for patients with malignant pleural effusion.

Is Talc Safe for Pleurodesis?

The talc used for talc pleurodesis is special, medical-grade talc that has been made sterile. Talk to your doctor to see if you have any underlying issues in your medical history that could make the use of talc unnecessarily dangerous. These may include allergies, pregnancy or breastfeeding, drug interactions, lung diseases, and breathing problems.

How Effective Is Talc Pleurodesis?

Talc pleurodesis is successful in about 70 percent to 80 percent of cases. When it is successful, this procedure can save the patient from having to undergo further invasive chest and lung surgeries to drain a buildup of fluids.

Complications, Side Effects, and Recovery

The main risk associated with talc pleurodesis is pain from irritation and inflammation. Since this is a known risk, patients are always given morphine-based painkillers and a local anesthetic before the procedure, as well as prescription painkillers after the procedure. Other side effects can include fever and flu-like symptoms in a day or two following the procedure.

Less often, patients may develop low blood pressure or a severe reaction where the lungs become inflamed, making it difficult to breathe. However, this occurs in less than 1 in 1,000 cases. Discuss the potential risks and benefits of talc pleurodesis in more detail with your doctor.

During recovery, you will need to keep the incision clean with daily gentle washes and change out your bandages at least once per day. Do not submerge your wound in a bathtub or swimming pool until your incision has fully healed. You should also avoid rubbing the wound or putting any lotion or ointment on the incision.

Do not lift any objects weighing more than 10 pounds without approval from your doctor. Some drainage from the wound is normal; however, if you experience a lot of drainage or signs of an infection, contact your doctor. How long it takes you to fully recover from your procedure depends on your specific case. Ask your doctor when you can resume your normal activities.

What Are Alternatives to Talc Pleurodesis?

One possible alternative to talc pleurodesis is an indwelling pleural catheter. A catheter places a small tube (much smaller than a chest tube) in the chest cavity to constantly drain excess fluids from the pleural space. You can also elect to keep your pleural space open and arrange repeat fluid removal procedures as necessary. Learn more about talc pleurodesis by asking your doctor.