Pulmonary Self-Study Resources-Asciak, BTS Clinical Statement on pleural procedures, Thorax 2023

Pdf Summary

The British Thoracic Society (BTS) released a comprehensive clinical statement on pleural procedures, highlighting their growing use and associated costs, while stressing the importance of updated practices due to associated risks and national safety alerts. The statement complements the BTS Guideline for Pleural Disease 2023, focusing on pleural interventions in adults and addressing areas like safety, patient selection, and procedure-specific complications.<br /><br />The statement emphasizes several pleural procedures, including pleural aspiration, intercostal drain insertion, indwelling pleural catheter (IPC) management, image-guided pleural biopsy, and medical thoracoscopy. Key safety measures outlined include the importance of operator training, proper procedural documentation, obtaining informed consent, and selecting appropriate medications. Routine blood tests and imaging are crucial for evaluating risks before procedures. Pleural ultrasonography is recommended for fluid aspirations to reduce risks.<br /><br />For pleural aspirations, the statement advises using small-bore needles, performing aspirations slowly, stopping if symptoms like chest tightness arise, and generally draining a maximum of 1.5 liters of fluid at one time. For intercostal drains, small-bore drains are preferred for most indications, and it’s crucial to monitor the volume drained to prevent complications like re-expansion pulmonary oedema (RPO).<br /><br />The document also discusses IPCs in malignant pleural effusion (MPE) management, addressing their controversial role in non-MPEs. It advises on IPC insertion, management, and removal, underscoring the need for meticulous care to prevent infections. Additionally, it highlights the significance of ultrasound-guided pleural biopsies for high diagnostic yield and the use of medical thoracoscopy for comprehensive pleural evaluations, stressing patient selection and necessary post-procedural care.<br /><br />The statement includes online appendices with practical guides on various pleural procedures to assist clinicians in secondary care settings. Overall, it underscores the importance of safety, training, and patient-centered approaches in pleural interventions to optimize outcomes and reduce complications.

Meta Tag

Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

British Thoracic Society

pleural procedures

clinical statement

pleural interventions

safety measures

patient selection

operator training