Various medical conditions can cause pleural effusions.
Some common causes are:
Congestive heart failure
Liver disease (cirrhosis)
End-stage renal disease
Lupus and other
Transudative: The pleural effusion fluid is similar
in character to the fluid normally present in the
pleural space. Transudative pleural effusions rarely
require drainage, unless they are very large. Ex.
Congestive heart failure
Exudative: The pleural effusion fluid has excess
protein, blood or evidence of inflammation or
infection. An exudative pleural effusion may require
drainage, depending on its size and the severity of
inflammation. Ex. Pneumonia and lung cancer.
5. SIGN & SYMPTOMS
Sign & symptoms which are caused by the
Pneumonia causes fever, chills and pleuritic
chest pain, whereas a malignant effusion may
result in dyspnea and coughing.
A large pleural effusion causes shortness of
breath. When a small to moderate pleural
effusion is present, dyspnea may be absent or
6. DIAGNOSTIC TEST
Pleural fluid is analyzed by bacterial culture, Gram
stain, acid fast bacillus stain (for TB), red and white
blood cell counts, chemistry studies (glucose,
amylase, lactic dehydrogenase, protein), cytologic
analysis for malignant cells, and pH.
A pleural biopsy also may be performed.
Treatment for pleural effusions may based on the
treatment of medical condition causing the pleural
effusion like giving antibiotics for pneumonia, or
diuretics for congestive heart failure.
Large, infected, or inflamed pleural effusions often
require drainage to improve symptoms and prevent
Various procedures may be used to treat pleural
effusions, Which are:
8. Thoracentesis: (described above) can remove large
amounts of fluid, effectively treating many pleural
Tube thoracotomy: (chest tube): A small incision is made
in the chest wall, and a plastic tube is inserted into the
pleural space. Chest tubes are attached to suction and are
often kept in place for several days.
Pleurodesis: An irritating substance is injected through a
chest tube, into the pleural space. The substance inflames
the pleura and chest wall, which then bind tightly to each
other as they heal. Pleurodesis can prevent pleural effusions
from recurring, in many cases.
9. Pleural drain: For pleural effusions that
repeatedly recur, a long-term catheter can be
inserted through the skin into the pleural space.
A person with a pleural catheter can drain the
pleural effusion periodically at home.
Pleural Decortication: Surgeons can operate
inside the pleural space, removing potentially
dangerous inflammation and unhealthy tissue.
Decortication may be performed using small
incisions (thoracoscopy) or a large one
10. NURSING Management
The nurse’s role in the care of the patient with a
pleural effusion includes implementing the medical
The nurse prepares and positions the patient for
thoracentesis and offers support throughout the
Pain management is a priority, and the nurse assists
the patient to assume positions that are the least
painful. However, frequent turning and ambulation
are important to facilitate drainage.
The nurse administers analgesics as prescribed and
11. If a chest tube drainage and water-seal system is
used, the nurse is responsible for monitoring the
system’s function and recording the amount of
drainage at prescribed intervals.
Nursing care related to the underlying cause of the
pleural effusion is specific to the underlying
condition If the patient is to be managed as an
outpatient with a pleural catheter for drainage,
The nurse is responsible for educating the patient
and family regarding management and care of the
catheter and drainage system.