fakingpatience Posted May 4, 2014 Share Posted May 4, 2014 Has anyone ever heard of a procedure used to "drain the fluid from the lungs" in severe CHF through aspirating the fluid in the lung (not the plural space)? I am taking prerequisites for school now, and one of my professors (who is a FMG) mentioned this procedure, called it a thoracentesis, but specifically stated you're going into the lung, not the plural space. Does this procedure exist, abet under a different name? It was also mentioned that you could put a "tube" into the lung and leave it there, similar to an NG, to drain blood from the lungs. Link to comment Share on other sites More sharing options...
whoRyou Posted May 4, 2014 Share Posted May 4, 2014 Ask and you shall receive Thoracentesis - Everything you wanted to know and then some Link to comment Share on other sites More sharing options...
fakingpatience Posted May 4, 2014 Author Share Posted May 4, 2014 All I can find on thoracentesis is draining from the plural space, taking care to avoid the lung; have you ever heard it done puncturing the lung specifically? Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted May 4, 2014 Moderator Share Posted May 4, 2014 All I can find on thoracentesis is draining from the plural space, taking care to avoid the lung; have you ever heard it done puncturing the lung specifically? No. He either misspoke, is ignorant, or you misunderstood. Puncturing the lung would only cause a pneumothorax. Link to comment Share on other sites More sharing options...
SHU-CH Posted May 5, 2014 Share Posted May 5, 2014 No. He either misspoke, is ignorant, or you misunderstood. Puncturing the lung would only cause a pneumothorax. This is accurate - someone has their wires crossed. Thoracentesis withdraws fluid from the pleural space. The presence of a pleural effusion is fairly common in CHF so he might have meant this. The "lung fluid"/pulmonary edema in CHF is in the interstitial space (initially) and the alveoli (later). Inserting a needle would have no effect. Link to comment Share on other sites More sharing options...
KMD16 Posted May 5, 2014 Share Posted May 5, 2014 Medicine is like learning a new language. The OP was in an unfamiliar territory. Link to comment Share on other sites More sharing options...
fakingpatience Posted May 5, 2014 Author Share Posted May 5, 2014 Please do no assume I am ignorant of medical terminology and procedures purely because I am not in PA school yet. There is much I have to learn, but I am going in with experience. I have observed both thoracentesis and a chest tube placement. The procedure my professor was describing didn't sound "right" so I asked for clarification, wondering if he was using the term lung for brevity purposes and actually meant the plural space. He insisted no, it was the lung that you punctured to drain the fluid from. I am already skeptical of things said by this teacher, due to him giving bad information in the past, but I didn't want to let my bias against him cause me to automatically assume this procedure doesn't exist, hence asking it here, to see if it was perhaps a rare, or old procedure that I couldn't find through googling. Oneal, thank for for your information. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 5, 2014 Share Posted May 5, 2014 Definitely not thoracentesis which is, as you know, removing fluid from the pleural space. As for CHF with severe pulmonary edema and volume overload, there are some cardiac centers that are doing aquapheresis (also called ultrafiltration) when the patient doesn't tolerate heavy diuresis or does not respond adequately. At this time it is mostly used as palliative treatment for the most severe class IV HF patients and is outrageously expensive (requires on average a 36-48hr ICU bed). Think of it like dialysis for the heart. They actually do use a dialyzer for this. I haven't seen it done so not quite sure on the details. Here's a brief overview...worth a lit search. http://www.healthline.com/health-blogs/tech-medicine/aquapheresis-new-treatment-heart-failure-part-1#5 Link to comment Share on other sites More sharing options...
HLReed Posted May 14, 2014 Share Posted May 14, 2014 Ultrafiltration (UF) is just the rate of fluid removal during renal replacement therapy. It can be performed with or without solute removal to achieve net negative fluid balance. If patients can't hemodynamically tolerate the large fluid shifts of intermittent hemodialysis, but still need fluid removal and are anuric, they can have CVVHD with a slow rate of UF for fluid removal. We do it all the time in the ICU for patients that are fluid overloaded but otherwise don't need dialysis. The dialysis access and equipment would be exactly the same, settings differ. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 14, 2014 Share Posted May 14, 2014 ^^thank you so much. I was on an IM residency interview so a bit nervous and didn't quite catch the details ???? Link to comment Share on other sites More sharing options...
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