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Pleurodesis: stopping fluid from coming back around the lung | CION Cancer Clinics
Pleurodesis is a procedure that makes the two layers of lining around the lung stick together, usually with sterile medical talc, so fluid cannot keep collecting. It is used when fluid caused by cancer returns again and again and makes you breathless. It treats the fluid, not the cancer. This page explains both methods, the hospital stay, who it does not suit and what else can help. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is pleurodesis, and why is it done?
- What are the two ways of putting talc in?
- What happens during your stay?
- What do people often misunderstand about pleurodesis?
- What do these words on your notes mean?
- Who is pleurodesis not suited to?
- How does pleurodesis compare with a home drain?
- Common questions about pleurodesis
The short answer
What is pleurodesis, and why is it done?
Pleurodesis is a procedure that makes the two layers of lining around the lung stick together, so fluid has no space to collect again. It is used when fluid keeps building up around the lung, often because of cancer, and keeps making you breathless.
Why the fluid keeps coming back
The lung sits inside a thin double lining called the pleura. Normally there is only a trace of fluid between the layers. Cancer in or near the lining can make far more fluid than the body can clear. Draining it with a needle helps for a while, but the fluid usually returns.
What sticks the layers together
Most often, sterile medical talc is placed between the layers. It causes a controlled irritation, and as the lining heals, the layers join and seal the space. Other substances are sometimes used, but talc is the most common.
Who is usually offered it
It is usually offered to people whose fluid has come back after at least one drain, whose breathing clearly improved when the fluid was removed, and whose lung opened out fully afterwards. That improvement in breathing matters. If draining the fluid did not help you breathe, the breathlessness probably has another cause, and sealing the space is unlikely to help. Ask the team what they saw when the fluid was last drained.
Pleurodesis treats the fluid. It does not treat the cancer that is causing it, so other treatment for the cancer usually carries on alongside.How it is done
What are the two ways of putting talc in?
Both aim for the same result. The choice depends on whether you also need a biopsy and how fit you are.
Through a chest drain
A soft tube is placed between the ribs under local anaesthetic, and the fluid is drained. Once the lung has opened out, talc mixed with liquid is passed down the tube. This is often called a talc slurry.
Often suits
- People who already have a diagnosis
- People not fit for an operation
During a thoracoscopy
A camera is passed into the chest, either under sedation or under a full anaesthetic by keyhole surgery. The doctor drains the fluid, can take biopsies, and blows a fine talc powder over the lining. This is often called talc poudrage.
Often suits
- People who still need a biopsy
- People fit for a short procedure
Not sure whether this applies to you?
Ask an oncologistIn hospital
What happens during your stay?
-
Before the procedure
You will have blood tests and a chest X-ray or ultrasound. If you take blood thinners such as aspirin, clopidogrel, warfarin or apixaban, tell the team. They will tell you what to do. Do not stop any medicine on your own.
-
Draining the fluid
The fluid is drained slowly, because removing too much at once can cause coughing or chest tightness. An X-ray checks that the lung has opened out fully.
-
The talc goes in
You may be given pain relief first. After a slurry, you may be asked to change position so the talc spreads. A clamp may be put on the drain for a short time.
-
The next few days
The drain stays in until very little fluid is coming out and the X-ray looks right. Chest aching and a temperature are common as the lining reacts to the talc.
-
Going home
The drain is removed and a stitch or dressing covers the small wound. You will be told how to look after it and when to come back.
Commonly believed
What do people often misunderstand about pleurodesis?
"The talc is the same as face or baby powder."
It is not. Medical talc is specially graded and made sterile for use inside the body. Never use household powder for any wound or tube.
"A fever afterwards means the procedure has gone wrong."
A mild temperature and aching are common in the first days because the talc irritates the lining on purpose. The team will still check you. A high fever with shivering, or one after you go home, needs to be seen quickly.
"Once it is done, the fluid can never come back."
Pleurodesis works for many people, but not for everyone. If the layers do not fully stick, fluid can return. There are other options if that happens.
"Draining fluid again and again is safer than a procedure."
Repeated needle drains mean repeated hospital visits and repeated risk each time. For fluid that keeps returning, a longer-term solution is usually kinder. Ask the team whether pleurodesis or a home drain makes sense before the next needle drain is booked.
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On your report
What do these words on your notes mean?
- Malignant pleural effusion
- Fluid around the lung caused by cancer. It can come from mesothelioma or from cancers that started elsewhere, such as breast or lung.
- Thoracoscopy
- Looking inside the chest with a camera through a small cut.
- Trapped lung
- A lung that cannot open fully because it is held down by a thick layer. Pleurodesis usually does not work when this is present.
- Re-expansion
- The lung opening out again once the fluid is drained.
Being straight with you
Who is pleurodesis not suited to?
It does not work well when the lung cannot open out, because the two layers need to touch to stick together. If the X-ray after draining shows a trapped lung, the team will usually suggest a different approach.
When a home drain may suit better
A thin tube left in the chest, called an indwelling pleural catheter, lets fluid be drained at home. It may suit people with a trapped lung, people who would rather avoid a hospital stay, and people for whom pleurodesis has not worked. Sometimes both are combined.
Other reasons it may not be suggested
If you are very unwell, a stay with a drain may be more burden than help. If the fluid is small and slow to return, simply watching it may be enough. If you are about to start treatment that could shrink the cancer, the team may wait to see whether the fluid settles.
This page cannot tell you which option suits you. Ask your team why they recommend one approach over another.Side by side
How does pleurodesis compare with a home drain?
Talc pleurodesis
Indwelling pleural catheter
A stay in hospital with a drain
Often a day procedure
Nothing to look after once healed
A tube and regular drainage at home
Needs the lung to open out fully
Works even with a trapped lung
Chest aching and fever in the first days
Risk of infection or blockage over time
Questions we are asked
Common questions about pleurodesis
Does pleurodesis hurt?
The drain is put in under local anaesthetic, so you feel pressure rather than sharp pain. Talc often causes aching in the chest over the next day or two. You will be given pain relief, and you should ask for more if it is not enough. Pain control helps you breathe deeply.
How long will I be in hospital?
It depends on the method and how quickly the fluid stops draining. A pleurodesis through a chest drain usually means a stay of a few days. Ask your team how long they expect for your situation so the family can plan.
Will my breathing be normal afterwards?
If fluid was the main cause of breathlessness, breathing often improves. But the cancer itself, weak muscles or other lung problems can still cause breathlessness. Ask what improvement is realistic for you before the procedure.
Is talc safe to have inside my chest?
Medical talc has been used for pleurodesis for a long time and is specially graded for it. Serious reactions are uncommon. Rarely, breathing can get worse after talc, which is why you are watched closely in hospital. Ask your team about the risks for you.
What if the fluid comes back after pleurodesis?
Tell your team if breathlessness returns. They will check with an X-ray or ultrasound. Options include a home drainage tube, another procedure, or drainage when needed. The right choice depends on how you are and what other treatment you are having.
Can I have chemotherapy after pleurodesis?
Usually, yes. Pleurodesis deals with the fluid, and treatment for the cancer can carry on. Your oncologist will decide the timing, particularly if you are still recovering from the procedure or the wound is healing.
Does pleurodesis make future chest surgery harder?
It can. Because the layers are stuck together, any later operation on that side of the chest is more difficult. If a larger operation might be considered later, tell the team, so they can plan the order of procedures with that in mind.
What should I watch for after going home?
Get help the same day for a high fever with shivering, redness or pus at the drain site, breathlessness that gets suddenly worse, or chest pain that is new or severe. For milder aching that is slowly improving, keep taking the pain relief you were given.
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Sources
- NHS — Mesothelioma: treatment
- National Cancer Institute — Malignant Mesothelioma Treatment (PDQ), patient version
- Cancer Research UK — Mesothelioma
- Macmillan Cancer Support — Mesothelioma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Indwelling Pleural Catheter at HomeThe main alternative when the lung cannot open outVATS Pleural Biopsy and TalcWhen talc is put in during a keyhole biopsyDraining Fluid From the Chest: What to ExpectWhat a chest drain feels like and how it comes outBreathlessness Relief From Pleural ProceduresWhat improvement in breathing is realistic
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Fluid keeps coming back around the lung?
Send us the latest scan and reports, or call the helpline. A specialist will explain the options for controlling it. One helpline serves every CION centre.