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

Pdf Summary

The British Thoracic Society (BTS) Clinical Statement on pleural procedures outlines comprehensive guidance for conducting various pleural interventions with a focus on clinical safety, patient selection, complication rates, the consent process, and troubleshooting. This statement complements the BTS Guideline for Pleural Disease 2023, specifically addressing pleural interventions in adults. Several types of procedures are detailed, including pleural aspiration, intercostal drain insertion, IPC management, image-guided pleural biopsy, and medical thoracoscopy.<br /><br />Key Areas of Focus:<br />1. **Safety and Preparation**:<br />   - Emphasizes adequate training and supervision of operators.<br />   - Encourages thorough documentation of procedures and outcomes.<br />   - Recommends patient consent in compliance with General Medical Council guidelines.<br /><br />2. **Pleural Aspiration**:<br />   - Ultrasound should guide thoracentesis to minimize complications.<br />   - Preference for small bore needles and avoiding the use of vacuum bottles or wall suction due to associated risks.<br />   - Advises stopping the procedure if the patient experiences symptoms like chest tightness or pain.<br /><br />3. **Intercostal Drain Insertion**:<br />   - Suitable for indications including pneumothorax, large pleural effusions, and pleurodesis.<br />   - Small-bore drains (14F) are generally preferred; large-bore drains for trauma or mechanical ventilation cases.<br />   - Ensures follow-up imaging to confirm accurate placement.<br /><br />4. **IPC Insertion, Management, and Removal**:<br />   - Indicated for recurrent malignant pleural effusions and, in select cases, for non-malignant effusions.<br />   - Discusses patient care post-insertion, including frequency and volume of fluid drainage.<br />   - Criteria for removal include minimal fluid drainage over consecutive times and lack of reaccumulation symptoms.<br /><br />5. **Image-Guided Pleural Biopsy**:<br />   - Provides procedural safety by targeting biopsy sites to minimize complications.<br />   - Uses low-frequency ultrasound probes and Doppler to screen for vessels, advising multiple core samples for diagnostics.<br /><br />6. **Medical Thoracoscopy**:<br />   - Suitable for pleural biopsies and septation breakdown in pleural effusion cases.<br />   - The statement discusses patient selection, sedation, procedural variations (rigid vs. semi-rigid scopes), and combination with interventions like talc poudrage or IPC.<br />  <br />Supplemental appendices online include guides for anesthesia, sample consent forms, techniques for pleural aspiration, drain insertion, and troubleshooting. This clinical statement aims to standardize high-quality, safe practices in pleural interventions while highlighting areas forthcoming research could address.<br /><br />Overall, the document serves as a pragmatic guide to help practitioners safely and effectively undertake pleural procedures, ensuring both best practice and patient safety.

Meta Tag

Asset Type PDF

Curriculum Category Pulmonary Disease in Critical Care

Keywords

pleural procedures

clinical safety

patient selection

complication rates

consent process

pleural aspiration

intercostal drain insertion

image-guided pleural biopsy

medical thoracoscopy

British Thoracic Society