In Nov 2011, when I went for a pleural tap or chest tap for my pleural effusion, the hospital gave me some information on pleural tap.
Pleural cavity is the potential space between the chest wall and the lungs. This space may be filled with fluid or air.
A pleural tap involves inserting a needle into the pelural cavity to draw out the fluid that has accumulated within this space.
This procedure may be done to diagnose a patient's condition in which case the fluid drawn may be sent for tests to detect infection or cancer cells. It may also be done to relieve the breathlessness a patient feels as a result of the fluid accumulation. (Note in my case, it was mostly done to relieve breathlessness and sometimes the fluid drawn was sent for tests as well.)
The patient will normally be sitting up during the procedure and usually leaning forward on a pillow on the side table. Local anaesthesia is injected into the site on the chest wall where the needle will be inserted. This site is usually at the back or side of the chest wall. The needle is then inserted in between the ribs, through the chest wall into the pleural cavity. Fluid is then drawn out.
Risks of a pleural tap
(figures based on Seneff et al Chest 1986 Jul; 90 (1); 97-100)
Pneumothorax
This occurs in about 10% of procedures. This occurs because air is leaking from the lung that is punctured during the procedure. The check Chest X-ray will be done to ensure this has not happened. If this complication occurs, the patient may need to stay in hospital and have a chest tube inserted to drain out the air that is leaking from the lung.
Bleeding
There is usually minimal or no blood loss during the procedure but significant loss may occur if there are clotting abnormalities. Precautions will be taken prior to the start of the procedure to ensure that blood loss is limited to the minimum. Occasionally, a chest will artery known as the intercostal artery may be lacerated during the procedure and bleed into the pleural cavity resulting in a condition known as haemothorax. The reported incidence is less than 1%, but the patient will require further treatment for such a complication.
Splenic/Liver Laceration
Is reported that in less than 1% of cases, the liver or spleen may be lacerated. This is a serious complication, which may result in severe blood loss in the intra-abdominal cavity. Open surgery may be needed to stop the bleeding.
Minor complications
The patient may cough more after the procedure as a result of the lung re-expansion. This occurs in about 10% of cases. A dry tap (that is, no fluid is drained) may be encountered in about 13% of procedures. A blood clot or cluid collection may arise under the skin post procedure in about 1-2% of cases but they are expected to resolve with time.
Showing posts with label chest tap. Show all posts
Showing posts with label chest tap. Show all posts
Wednesday, 30 November 2011
Saturday, 5 November 2011
Pleural Effusion & Pleural Tap
For the past few months till now, I have been struggling to cope with aches and pains from rheumatism on the right shoulder, muscle pulls and cramps on the back and thighs and pain on the lower back.
I struggled to lie down and I struggled to turn in bed. I struggled even more to get up. Sometimes the pain was too much that I needed a family member to help pull me up. I was not sleeping well. It was also an effort to either sit down or stand up. I had to be extra careful go slow when alighting from buses as my lower back hurts.
I was dependent on painkillers and the times that I have to leave home, I brought painkillers with me.
I also noticed that I have a lot of phlegm, followed by breathlessness and now coughing, a sure sign that my chest is flooded again.
Nov 3 2011, I went to the National Cancer Centre's emergency walk-in clinic. The doctor ordered blood test and x-ray. The x-ray confirmed that the pleural space of my left chest was half covered in fluid. I thought it a little strange as my problem area is my right side and the last time it happened, usually it was my right pleural space that was flooded first. Anyway, at least I have the right lung free to let me breathe.
Nov 4 2011, the attending doctor did a pleural tap, using a syringe, and drew 850 ml of fluid from my left pleural space. This doctor was not as experienced as the one I had in 2008. She gave me a few doses of local anaesthetic but was unable to find a spot to insert the syringe. I had been having pain on the left side of my back around the ribcage area and I suspected that the area was swollen. She commented that my ribs were so close together that she could not find a gap. When she finally tried to insert the syringe, I felt pain despite the anaesthetic. She stopped immediately and called a senior doctor to help. By the time she was done with the tapping, my chest felt tight and I was breathless and coughing, and I had to be given oxygen.
I had several chest taps done in 2008, and I do not remember having tight chest feeling nor coughing, and I also did not need oxygen then. I remembered the doctor had said that the procedure had to be done real slow and steady or the patient will feel discomfort.
The chest tap gave me temporary relief and the flooding is expected to be back as long as the cancer cells are running wild.
I struggled to lie down and I struggled to turn in bed. I struggled even more to get up. Sometimes the pain was too much that I needed a family member to help pull me up. I was not sleeping well. It was also an effort to either sit down or stand up. I had to be extra careful go slow when alighting from buses as my lower back hurts.
I was dependent on painkillers and the times that I have to leave home, I brought painkillers with me.
I also noticed that I have a lot of phlegm, followed by breathlessness and now coughing, a sure sign that my chest is flooded again.
Nov 3 2011, I went to the National Cancer Centre's emergency walk-in clinic. The doctor ordered blood test and x-ray. The x-ray confirmed that the pleural space of my left chest was half covered in fluid. I thought it a little strange as my problem area is my right side and the last time it happened, usually it was my right pleural space that was flooded first. Anyway, at least I have the right lung free to let me breathe.
Nov 4 2011, the attending doctor did a pleural tap, using a syringe, and drew 850 ml of fluid from my left pleural space. This doctor was not as experienced as the one I had in 2008. She gave me a few doses of local anaesthetic but was unable to find a spot to insert the syringe. I had been having pain on the left side of my back around the ribcage area and I suspected that the area was swollen. She commented that my ribs were so close together that she could not find a gap. When she finally tried to insert the syringe, I felt pain despite the anaesthetic. She stopped immediately and called a senior doctor to help. By the time she was done with the tapping, my chest felt tight and I was breathless and coughing, and I had to be given oxygen.
I had several chest taps done in 2008, and I do not remember having tight chest feeling nor coughing, and I also did not need oxygen then. I remembered the doctor had said that the procedure had to be done real slow and steady or the patient will feel discomfort.
The chest tap gave me temporary relief and the flooding is expected to be back as long as the cancer cells are running wild.
Tuesday, 26 August 2008
Chest Tap - Right Lung Again
4 Aug 08, Monday - I had another 300mg of herceptin.
I had no appointment with Dr Wong and when I complained of breathlessness, the doctor on duty at the chemo unit sent me for an x-ray. She decided that I didn't need a chest tap. I had also wanted to have the central line taken out, but she would rather I checked with Dr Wong first.
13 Aug 08, Wednesday - I had another physiotherapy session for manual lymph drainage. I had been having weekly sessions since July.
My breathing was getting more and more laborious. No appointment with Dr Wong today, so after my physio session, I had to go the NCC walk-in clinic. The doctor sent me for an x-ray and concluded that I needed a chest tap. He also ordered a blood test for me.
At the chemo unit, from the x-ray, they found that my right lung had more fluid. So a chest tap was done on the right lung and they managed to draw 1.2ltrs of fluid. Before the tap, when I walked from NCC to block 4, I had to stopped half way to catch my breath. After this tap, my breathing was easier.
The x-ray taken after the tap showed my right lung nearly cleared of fluid while the left lung was still nearly half covered. I had asked the doctor if it was possible to tap both lungs together and she said no, 'otherwise I have no lungs to breathe'.
18 Aug 08, Monday - I had another heart function (MUGA) test.
19 Aug 08, Tuesday - Another physiotherapy session.
I had been going to SGH and NCC so often that it was like my second home. This is one second home that I would rather do without if I had a choice.
I had no appointment with Dr Wong and when I complained of breathlessness, the doctor on duty at the chemo unit sent me for an x-ray. She decided that I didn't need a chest tap. I had also wanted to have the central line taken out, but she would rather I checked with Dr Wong first.
13 Aug 08, Wednesday - I had another physiotherapy session for manual lymph drainage. I had been having weekly sessions since July.
My breathing was getting more and more laborious. No appointment with Dr Wong today, so after my physio session, I had to go the NCC walk-in clinic. The doctor sent me for an x-ray and concluded that I needed a chest tap. He also ordered a blood test for me.
At the chemo unit, from the x-ray, they found that my right lung had more fluid. So a chest tap was done on the right lung and they managed to draw 1.2ltrs of fluid. Before the tap, when I walked from NCC to block 4, I had to stopped half way to catch my breath. After this tap, my breathing was easier.
The x-ray taken after the tap showed my right lung nearly cleared of fluid while the left lung was still nearly half covered. I had asked the doctor if it was possible to tap both lungs together and she said no, 'otherwise I have no lungs to breathe'.
18 Aug 08, Monday - I had another heart function (MUGA) test.
19 Aug 08, Tuesday - Another physiotherapy session.
I had been going to SGH and NCC so often that it was like my second home. This is one second home that I would rather do without if I had a choice.
Monday, 25 August 2008
Chest Tap - Right Lung
14 Jul 2008, Monday - Saw Dr Wong before my herceptin iv. She referred to the brain, chest and abdomen ct of 7 July and commented that there was a lot of improvement and that the metastases have shrunk.
Shrunk? I was expecting to hear her said that they have disappeared, and asked, " you mean they are still there?" She said, "of course, not so fast". So, after 5 doses of chemo that left me weak and suffering from side-effects, the cancer cells have not been eradicated. I was disappointed.
As my right arm had water retention, Dr Wong arranged for me to see a physio-therapist.
I went to the chemo unit to have my chest tapped. 1 ltr of fluid was tapped from my right lung. After each chest tap, I'd had to have a chest x-ray taken. The right lung was quite clear now, but the left lung still had pleural effusion. It came back again after the June tapping.
After the chest tap, I had 300mg of herceptin by iv.
The blood test in the morning, before I saw Dr Wong, showed my cancer marker had dropped to 16.
Shrunk? I was expecting to hear her said that they have disappeared, and asked, " you mean they are still there?" She said, "of course, not so fast". So, after 5 doses of chemo that left me weak and suffering from side-effects, the cancer cells have not been eradicated. I was disappointed.
As my right arm had water retention, Dr Wong arranged for me to see a physio-therapist.
I went to the chemo unit to have my chest tapped. 1 ltr of fluid was tapped from my right lung. After each chest tap, I'd had to have a chest x-ray taken. The right lung was quite clear now, but the left lung still had pleural effusion. It came back again after the June tapping.
After the chest tap, I had 300mg of herceptin by iv.
The blood test in the morning, before I saw Dr Wong, showed my cancer marker had dropped to 16.
Tuesday, 12 August 2008
Chest Tab - Right Chest
Sometimes, with chemo, the pleural effusion will resolve itself. In my case, it didn't, so I was still highly dependent on oxygen.
The ward doc tried to reduce the volume of oxygen, but after checking on the fingertip pulse oximeter, he had to set it back to 5 ltrs again. He mentioned that we had to do a chest tap. Memories of Changi came flooding back. I asked if a syringe could be used to draw fluid instead, and, surprise, he said he would use a syringe.
There were certain things to watch out for in doing a chest tap, and that is that there could be bleeding or air could get sucked in.
I was to have the chest tap done on the hospital bed. I sat at the edge of one side of the bed, holding onto the trolley table. The doc sat on the bed behind me and used a syringe to tap the fluid from my chest. He had with him a junior doctor that he was also teaching and guiding and a nurse to give assistance. He said that they would be drawing the fluid until I started coughing. I didn't understand what he meant. I had stopped coughing ever since they gave me cough mixture to stop my cough after I had the chest pain so that my chest would not be stressed further.
Initially, when the tapping started, I felt fine. But as more and more fluid was tapped, I could feel the cough coming and tried to control myself. Then, suddenly, it felt as though the right side of my throat had a lot of air bubbling up. I was coughing like crazy by now and they had to stop tapping. They had managed to tap about 700 ml of fluid from my right chest. The doc said he had wanted to tap more if I hadn't started coughing.
The whole procedure lasted half an hour or less. After that, my breathing improved. It was a relief.
Slowly, I tried to wean myself from the oxygen as I was worried that I might be too dependent on it.
The ward doc tried to reduce the volume of oxygen, but after checking on the fingertip pulse oximeter, he had to set it back to 5 ltrs again. He mentioned that we had to do a chest tap. Memories of Changi came flooding back. I asked if a syringe could be used to draw fluid instead, and, surprise, he said he would use a syringe.
There were certain things to watch out for in doing a chest tap, and that is that there could be bleeding or air could get sucked in.
I was to have the chest tap done on the hospital bed. I sat at the edge of one side of the bed, holding onto the trolley table. The doc sat on the bed behind me and used a syringe to tap the fluid from my chest. He had with him a junior doctor that he was also teaching and guiding and a nurse to give assistance. He said that they would be drawing the fluid until I started coughing. I didn't understand what he meant. I had stopped coughing ever since they gave me cough mixture to stop my cough after I had the chest pain so that my chest would not be stressed further.
Initially, when the tapping started, I felt fine. But as more and more fluid was tapped, I could feel the cough coming and tried to control myself. Then, suddenly, it felt as though the right side of my throat had a lot of air bubbling up. I was coughing like crazy by now and they had to stop tapping. They had managed to tap about 700 ml of fluid from my right chest. The doc said he had wanted to tap more if I hadn't started coughing.
The whole procedure lasted half an hour or less. After that, my breathing improved. It was a relief.
Slowly, I tried to wean myself from the oxygen as I was worried that I might be too dependent on it.
Sunday, 3 August 2008
Where Is The Doctor?
Back at the ward, I grabbed the oxygen tube (called nasal prong, I think - the one without the mask). No difference. I buzzed the nurse and was told they would page for my doctor. Meanwhile, I tried ever so hard to take in oxygen, but found that I could not breathe in. It was like my lungs froze.
I tried to calm myself down. Okay.. okay.. don't panic.. easy.. relax.. relax... try again - didn't work! In between, I kept buzzing for the nurses at 15 or 20 minutes interval, and they kept assuring me that my doc had been paged and should be coming. Sometimes, they would 'measure my oxygen' by using a fingertip pulse oximeter - where they clipped the 'probe' onto the finger, and they kept saying my oxygen level is okay.
In the meantime, a group of doctors passed by my room. A number of doctors in that group had attended to me at one time or another since I was admitted. A short while later, they went back past my room again. I told nurse M, who was nearby, to quickly get one of the doctors for me. She just wheeled round on her heels and stare at the group as they disappeared from view, and turned back to look blankly at me again. She did not go after them, neither did she called out to them. I was aghast.
They kept telling me my doc had been paged and would be coming, but after more than an hour, there was still no sign of the doc. I was sick, I can't breathe and was breaking out in cold sweat. So many doctors had seen me and I needed a doc then, only one, any one would do, so where is the doc?
Finally, more than an hour later, Dr A, (one of those in the earlier group), came back and stopped at the nurses' station. I buzzed for a nurse again, and told her I could not breathe, she brought the fingertip pulse oximeter again. I told her I didn't want that. I was desperate, I was mad, my patience was gone. I wanted a doc, he was at the nurses' station, call him for me. Probably alarmed by my behaviour, she went, fortunately, because I was all ready to muster whatever strength I could to holler across the room for the doc. Sorry, but desperate situations call for desperate measures and I could not afford to be nice anymore.
By the time Dr A came to me, my arms were shaking. I had been holding onto the side rails for support. I told him, "I can't breathe; I am breaking out in cold sweat; I can't hold on any longer; Do something". And I passed out.
I tried to calm myself down. Okay.. okay.. don't panic.. easy.. relax.. relax... try again - didn't work! In between, I kept buzzing for the nurses at 15 or 20 minutes interval, and they kept assuring me that my doc had been paged and should be coming. Sometimes, they would 'measure my oxygen' by using a fingertip pulse oximeter - where they clipped the 'probe' onto the finger, and they kept saying my oxygen level is okay.
In the meantime, a group of doctors passed by my room. A number of doctors in that group had attended to me at one time or another since I was admitted. A short while later, they went back past my room again. I told nurse M, who was nearby, to quickly get one of the doctors for me. She just wheeled round on her heels and stare at the group as they disappeared from view, and turned back to look blankly at me again. She did not go after them, neither did she called out to them. I was aghast.
They kept telling me my doc had been paged and would be coming, but after more than an hour, there was still no sign of the doc. I was sick, I can't breathe and was breaking out in cold sweat. So many doctors had seen me and I needed a doc then, only one, any one would do, so where is the doc?
Finally, more than an hour later, Dr A, (one of those in the earlier group), came back and stopped at the nurses' station. I buzzed for a nurse again, and told her I could not breathe, she brought the fingertip pulse oximeter again. I told her I didn't want that. I was desperate, I was mad, my patience was gone. I wanted a doc, he was at the nurses' station, call him for me. Probably alarmed by my behaviour, she went, fortunately, because I was all ready to muster whatever strength I could to holler across the room for the doc. Sorry, but desperate situations call for desperate measures and I could not afford to be nice anymore.
By the time Dr A came to me, my arms were shaking. I had been holding onto the side rails for support. I told him, "I can't breathe; I am breaking out in cold sweat; I can't hold on any longer; Do something". And I passed out.
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