[citation needed] Chemicals such as bleomycin, tetracycline (e.g., minocycline),[2] povidone-iodine, or a slurry of talc can be introduced into the pleural space through a chest drain.

[3] Pharmacy-prepared chemicals for pleurodesis should be clearly labeled "NOT FOR IV ADMINISTRATION"[4] to avoid potentially fatal wrong-site medication errors.

[5] Sterile talc powder, administered intrapleurally via a chest tube, is indicated as a sclerosing agent to decrease the recurrence of malignant pleural effusions in symptomatic patients.

[citation needed] Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.

This involves mechanically irritating the apical and the costal pleura, often with a scratchpad (a small foam pad with coated abrasive) normally used for cleaning electrocautery blade tips.