Introduction BTS Pleural disease guidelines in 2010 strongly recommend thoracic ultrasound guidance for all pleural procedures for pleural fluid, and at least level 1 competency is required to safely perform independent thoracic ultrasound. In line with this, our Respiratory department developed a dedicated pleural service over a span of last 10 months. Here we report the pleural service at our hospital and training opportunities for senior and junior level trainees.
Method We retrospectively assessed all the scans done by the Respiratory Department since start of our pleural service in september 2011
Results The total number of ultrasound scans done, based on the radiological appearance of pleural effusion –154 patients x 2 sides=308. Males 100 (200 scans), and females 54 (108 scans). Age of the patient ranging from 30 to 94 with average age of 71 yrs. Ultrasound findings include unilateral effusions in 129 patients, bilateral in 18, and no effusion in 7 patients. Total 100 pleural procedures (diagnostic/therapeutic inspirations, chest drain insertion) were done under ultrasound guidance, and had only 1 complication of pneumothorax. This is thought possibly be due to ‘trapped lung’. In 79 patients the effusion was small on chest x-ray, and out of which 41 patients we aspirated under guidance, but in 38 patients (48% of small effusions and 25% of all scans) the effusion was too small to be aspirated safely even under ultrasound guidance, so not intervened. pH of the pleural fluid ranged from 6.25–7.69. 16 patients had pH<7.2, out of which 5 were empyema, 3 malignancy, and 3 rheumatoid. Pleural fluid cytology was positive for malignancy in 18 patients, and microbiology was positive in 6 patients. AAFB was negative in all patients.
During the last 6 months, 2 Consultants’ and 3 Specialist Registrars’ achieved level 1 competency and working towards level 2. We have 3 half a day fixed sessions each week, and so far we have trained 8 junior level (include CT2, CT1, FY2, FY1) trainees who managed to attend our pleural sessions.
Conclusion Setting up a dedicated ultrasound guided pleural service vastly minimises the complications associated with pleural procedures, improves patient care, and provides great training opportunities for senior and junior level trainees. Our data strengthens the importance and safety of ultrasound guided pleural procedures.