Dr Awaneesh Katiyar MBBS MS MCh PGDDM
“Together, we can prevent accidents and related preventable deaths on the road and in hospitals ”.
Intra-pleural Streptokinase therapy
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Dr Awaneesh Katiyar (Trauma Surgeon)
(MBBS, MS, MCh, PGDDM)
Indications – Retained Hemothorax
Retained Hemothorax – Retained hemothorax is defined as residual clots at least 500 ml large, or in which at least one-third of the blood in the pleural space cannot be drained by a chest tube after 72 h of initial treatment revealed by computed tomography (CT) scan.
Method– Dilute 250,000 IU of streptokinase in 100 mL of saline solution and administer it through the chest tube. Clamp chest tube for 4 hours, and ask the patient to rotate in different positions to allow for better distribution of intrapleural streptokinase. After the 4 hours, de-clamp the chest tube and allow content to come out. The procedure can be repeated 3-6 times or till chest X-rays becomes clear or content less than 100 mL in 24 hours.
Complications
1. Allergic reaction or anaphylaxis reaction
2. Increase in chest pain
3. Re-bleeding in the early phase of retained hemothorax.
4. Repositioning of Chest tube may be required in a few cases.
References
1. Abu-Daff S, Maziak DE, Alshehab D, Threader J, Ivanovic J, Deslaurier V, Villeneuve PJ, Gilbert S, Sundaresan S, Shamji F, Lougheed C. Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions—analysis of predictors for failure of therapy and bleeding: a cohort study. BMJ open. 2013 Feb 1;3(2):e001887.
2. Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bolliger CT. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. American journal of respiratory and critical care medicine. 2004 Jul 1;170(1):49-53.
3. Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Current opinion in pulmonary medicine. 2015 Jul;21(4):393.
