If lady has pleurx placed for recurrent malignant effusion and then found to have complicated parapneumonic effusion based on analysis and culture. Would you just use pleurx to drain and put on abx or need to replace pleurx
If lady has pleurx placed for recurrent malignant effusion and then found to have complicated parapneumonic effusion based on analysis and culture. Would you just use pleurx to drain and put on abx or need to replace pleurx
If lady has pleurx placed for recurrent malignant effusion and then found to have complicated parapneumonic effusion based on analysis and culture. Would you just use pleurx to drain and put on abx or need to replace pleurx
Ive seen it go both ways, not sure there is a definite right answer but most would probably remove pleurx.
That being said you need to be damn sure it is actually infected and not a pseudoexudate (eg fevers, lung infiltrate, low pH/glucose). An ultrasound showing septations in a chronic effusion with a fever in an immunocompromised person without damning pleural effusion labs would not be overly compelling for me unless no other source could be found or clinical status worsens.
Note, I am not a pulmonologist...but I 'play' one each month in the ICU sometimes (including floor consults)
I am not sure there is a right answer here, except for:
1. Be patient...or, as @jdh71 said, be ready to see this patient often...and then again...and wait for abx...and wait some more
2. skip ultrasound for early CT
3. call CTSx early; too often I see these cases and the medical docs are dicking around when the CTSx may provide a more rapid and definitive answer (even if it "only" gets the patient feeling better and onto a hospice course)
HH