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A patient has been admitted with pleural effusion. How should talc be administered?

Pleurodesis is a procedure used to treat recurrent pleural effusion or pneumothorax.

Talc is the chemical sclerosant of choice for pleurodesis based on efficacy. Since January 2008, the Medicines and Healthcare products Regulatory Agency has classified talc as a medicinal product. National guidelines recommend the use of 4g or 5g of sterile-grade talc in 50ml sodium chloride 0.9%. The talc slurry is administered into the pleural space via a chest drain.

Intrapleural administration of sclerosing agents may be painful. Discomfort can be reduced by administering a local anaesthetic through the drain before pleurodesis. The most frequently studied local anaesthetic for intrapleural administration is lidocaine.

Analgesia should also be given to the patient after the procedure; however, non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2 inhibitors and oral/intravenous corticosteroids should not be administered for 48 hours before and up to five days after the procedure, because these may reduce the pleura’s inflammatory response to the talc.

There are no recommendations for monitoring within UK guidelines, but the following parameters can be considered: respiratory rate, temperature, pulse, oxygen saturation, blood pressure, chest pain and attributes of the fluid in the drain bottle (eg, colour, volume, bubbling, swinging).

All suspected adverse effects from the use of talc should be reported to the MHRA via its yellow card scheme.

Citation: Clinical Pharmacist URI: 11096168

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