Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010

Published on Aug 1, 2010in Thorax8.834
· DOI :10.1136/THX.2010.137026
Tom Havelock10
Estimated H-index: 10
(Southampton General Hospital),
Richard Teoh6
Estimated H-index: 6
Diane Laws3
Estimated H-index: 3
In hospital practice, pleural aspiration (thoracocentesis) and chest drain insertion may be required in many different clinical settings for a variety of indications. Doctors in most specialities will be exposed to patients requiring pleural drainage and need to be aware of safe techniques. There have been many reports of the dangers of large-bore chest drains and it had been anticipated that, with the previous guidelines, better training and the advent of small-bore Seldinger technique chest drains, there would have been an improvement. Unfortunately the descriptions of serious complications continue, and in 2008 the National Patient Safety Agency (NPSA) issued a report making recommendations for safer practice.1 These updated guidelines take into consideration the recommendations from this report and describe the technique of pleural aspiration and Seldinger chest drain insertion and ultrasound guidance. Much of this guideline consists of descriptions of how to do these procedures but, where possible, advice is given when evidence is available. Before undertaking an invasive pleural procedure, all operators should be appropriately trained and have been initially supervised by an experienced trainer. Many of the complications described in the NPSA report were the result of inadequate training or supervision. A recent survey of UK NHS Trusts showed that the majority did not have a formal training policy for chest drain insertion in 2008.2 Studies of clinical practice have shown that there is a wide variation in the knowledge and skills of doctors inserting chest drains. In a published study3 where doctors were asked to indicate where they would insert a chest drain, 45% indicated they would insert the drain outside of the safety triangle, …
📖 Papers frequently viewed together
202 Citations
89 Citations
1,452 Citations
#1Ann Harris (Royal University Hospital)H-Index: 1
#2B Ronan O'DriscollH-Index: 18
Last. Peter TurkingtonH-Index: 8
view all 3 authors...
Background Following reports from the National Patient Safety Agency of deaths and serious harm from intercostal chest drains (ICD) we conducted a national survey among chest physicians of their experience of harm associated with ICD. Methods A questionnaire was sent to 198 UK chest physicians at 148 acute hospital trusts, enquiring about current practice and any adverse incidents related to chest drains from 2003 to 2008. Results 101 of 148 trusts (68%) replied. 67 trusts reported at least one ...
89 CitationsSource
To compare treatment success of large- and small-bore chest drains in the treatment of spontaneous pneumothoraces the case-notes were reviewed of those admitted to our hospital with a total of 73 pneumothoraces and who were treated by trainee doctors of varying experience. Both a large- and a small-bore intercostal tube drain system were in use during the two-year period reviewed. Similar pneumothorax profile and numbers treated with both drains were recorded, resulting in a similar drain time a...
30 CitationsSource
#1Andrew MacDuffH-Index: 1
#2Ross MacDuff (Glasgow Royal Infirmary)H-Index: 1
1 CitationsSource
#1T. JosephsonH-Index: 6
#2C. A. NordenskjoldH-Index: 1
Last. Magnus KaijserH-Index: 30
view all 5 authors...
Background: It has been suggested that no upper limit of the fluid amount drained is necessary when performing ultrasound-guided thoracentesis, but the risk of pneumothorax when large amounts of fluid are drained has not been studied in detail.Purpose: To study the amount of drained fluid at ultrasound-guided thoracentesis and the subsequent risk of pneumothorax.Material and Methods: Prospectively collected information on all ultrasound-guided thoracenteses performed at a county hospital between...
37 CitationsSource
#1Nagmi R Qureshi (Papworth Hospital)H-Index: 4
#2Najib M. RahmanH-Index: 46
Background: Malignant pleural effusion (MPE) is a common clinical problem with described investigation pathways. While thoracic ultrasound (TUS) has been shown to be accurate in pleural fluid detection, its use in the diagnosis of malignant pleural disease has not been assessed. A study was undertaken to assess the diagnostic accuracy of TUS in differentiating malignant and benign pleural disease. Methods: 52 consecutive patients with suspected MPE underwent TUS and contrast-enhanced CT (CECT). ...
163 CitationsSource
#1L. Linkson (St Thomas' Hospital)H-Index: 1
#2P. J. Rees (St Thomas' Hospital)H-Index: 1
9 CitationsSource
#1Helen E. Davies (Churchill Hospital)H-Index: 23
#2Shairoz Merchant (Royal Berkshire Hospital)H-Index: 1
Last. Anne McGown (Royal Berkshire Hospital)H-Index: 3
view all 3 authors...
Background and objective: Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. Methods: A retrospective case note audit wa...
56 CitationsSource
Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, cath...
49 CitationsSource
Background: A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the mid-clavicular line (MCL), using a 4.5-cm (2-inch) catheter (5-cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. Objectives: T...
73 CitationsSource
#1Tzu-Hsiu Tsai (NTU: National Taiwan University)H-Index: 14
#2Jih-Shuin Jerng (NTU: National Taiwan University)H-Index: 19
Last. Pan-Chyr Yang (NTU: National Taiwan University)H-Index: 119
view all 3 authors...
Transthoracic ultrasound (US) has become an important diagnostic tool in modern chest medicine. The range of thoracic lesions for which transthoracic US may yield useful diagnostic information has expanded to include not only chest wall and pleural lesions, but also peripheral lung nodules, pulmonary consolidations, necrotizing pneumonias and lung abscesses, tumors with obstructive pneumonitis, mediastinal masses, and peridiaphragmatic lesions. A variety of ultrasound features and signs of chest...
12 CitationsSource
Cited By410
This statement summarises basic settings in lung ultrasonography and best practice recommendations for lung ultrasonography in COVID-19, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR). Standard lung settings and artefacts in lung ultrasonography are explained for education and training, equipment settings, documentation and self-protection.
Point-of-care ultrasound (POCUS) is a noninvasive imaging tool with both diagnostic and therapeutic applications. In this article, the author will review the role of POCUS for vascular access, endotracheal intubation, lumbar puncture, chest tube, and diagnosing coronavirus disease 2019 lung pathology. This will include a review of the evidence, technique, and strategies for optimizing performance of these procedures. [Pediatr Ann. 2021;50(10):e404-e410.].
#1Katarzyna Faber (Medical University of Warsaw)H-Index: 1
#2Rafał Krenke (Medical University of Warsaw)H-Index: 17
The aim of this paper is to present basic data on pleural manometry and to outline the advances in its use as both a research tool enabling a better understanding of pleural pathophysiology and as a clinical tool useful in management strategy planning in patients with pleural diseases. To discuss updates and current trends in the development of pleural manometry, a search of the literature on pleural manometry published in recent years was performed. The technique of pleural manometry has signif...
(1) Background: Malignant (MPE), parapneumonic (PPE) and tuberculous (TPE) pleural effusions constitute common causes of pleurisy. Discriminating among them is usually challenging. C-reactive protein (CRP) and adenosine deaminase (ADA) pleural levels (p-CRP, p-ADA) have been used as differentiators in many studies showing promising results. This study aims to evaluate the diagnostic value of p-CRP, p-ADA levels and their combination among the three categories. (2) Methods: A prospective study of...
Background null This was an observational, cross-sectional, and multicentre study carried out from October to December 2020, through a survey sent to Spanish Society of Pulmonology and Thoracic Surgery members in public hospitals with different levels of complexity. Our objective was to complete a national analysis of clinical practice, organisation, infrastructure, the services portfolio, teaching, and research activity related to ultrasound. null Results null Data from 104 hospitals were analy...
#2Jamal Qaddumi (An-Najah National University)H-Index: 4
Last. Muhammad W. Darawad (UJ: University of Jordan)H-Index: 14
view all 3 authors...
Abstract null Background null Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses' level of knowledge regarding chest drain care. null Methods null ...
#1Helen McDill (Derriford Hospital)
#2Maged Hassan (Derriford Hospital)
Last. C Daneshvar (Derriford Hospital)H-Index: 2
view all 6 authors...
#1Simon James Buckley (University of Cambridge)
#2John Adu (University of Cambridge)
Last. Atul Gupta (University of Cambridge)H-Index: 21
view all 4 authors...
Primary spontaneous pneumothorax (PSP) is an uncommon presentation in children but may occur at any age and occurs in patients with no pre-existing lung disease. Management aims are to re-expand the collapsed lung, relieve pressure in the intrapleural space and avoid a tension pneumothorax. Correct management of PSP will avoid unnecessary intervention, reduce length of hospital stay and also reduce the risk of recurrence. There are no established guidelines for treating PSP in children and there...
2 CitationsSource
#1Ashkon Shaahinfar (Children's Hospital Oakland)H-Index: 4
#2Zahra M. Ghazi-Askar (Stanford University)
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central ...
Pleural effusions are a common finding in critically ill patients and small bore chest drains (SBCD) are proven to be efficient for pleural drainage. The data on the potential benefits and risks of drainage remains controversial. We aimed to determine the cut-off volume for complications, to investigate the impact of pleural drainage and drained volume on clinically relevant outcomes. Medical records of all critically ill patients undergoing insertion of SBCD were retrospectively examined. We sc...