From the Guidelines
The purpose of lytics through a chest tube is to break down and dissolve blood clots or fibrin deposits that are causing a blockage or preventing proper drainage of the pleural space, and this procedure is primarily used for complicated pleural effusions, hemothorax, or empyema when simple drainage is inadequate due to loculations or thick fluid. The medication is instilled directly into the chest tube, which is then clamped for 1-4 hours to allow the medication to work before unclamping to restore drainage. The use of intrapleural fibrinolytic drugs, such as urokinase or tissue plasminogen activator, has been shown to shorten hospital stay and improve patient outcomes in children with complicated parapneumonic effusions or empyema 1. Some key points to consider when using lytics through a chest tube include:
- The choice of fibrinolytic agent, with options including urokinase, tissue plasminogen activator, and streptokinase 1
- The dose and administration schedule of the fibrinolytic agent, with typical doses ranging from 2-10 mg diluted in 50-100 mL of normal saline 1
- The potential complications of the procedure, including bleeding, allergic reactions, and fever, and the need for close monitoring of patients during and after the procedure 1
- The potential need for multiple doses of the fibrinolytic agent over several days, depending on clinical response and drainage improvement 1. According to the most recent and highest quality study, both chest tube drainage with fibrinolysis and VATS are considered acceptable initial drainage strategies for complicated, loculated effusions 1.
From the Research
Purpose of Lytics through Chest Tube
- The purpose of lytics, such as tissue plasminogen activator (tPA), through a chest tube is to dissolve fibrin deposits and loculations within the pleural space, facilitating drainage of trapped pleural fluid surrounding the lungs 2.
- Fibrinolytic therapy can be effective for management of complex pleural effusions, and tPA has emerged as a treatment option for patients with complicated parapneumonic effusion that does not respond to medical management and drainage 2, 3.
- The use of lytics through a chest tube can break up loculations and early pleural peel, thereby facilitating pleural space drainage, especially in cases of loculated pleural effusions 4.
Mechanism of Action
- Lytics, such as tPA, work by breaking up fibrin and loculations that characterize complicated pleural effusions, facilitating drainage 2, 5.
- The dwell time of the lytic agent can affect its efficacy, with longer dwell times potentially being more effective 3.
Clinical Applications
- Lytics through a chest tube can be used to treat parapneumonic effusions, empyema, and other types of pleural effusions that are resistant to conventional drainage 2, 3, 4, 5.
- This treatment approach can be particularly useful in patients for whom surgery is not a safe or desired option 2.
- Lytics can also be used in pediatric patients with parapneumonic effusions, providing a less invasive alternative to surgical intervention 5.