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Printed at: 12:05:16 / 21-09-2021

Pleural Clinic – Information Sheet

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INTRODUCTION

This leaflet is being given to you to explain Pleural Procedures and what will happen on the day of your appointment.

Please read all of this leaflet carefully.

Locations for pleural procedures

Pleural Procedures are undertaken in the Main Outpatient department and in AECU. Please check your appointment letter carefully as to which location you should attend. Car parking charges apply. Please allow 2 hours for the hospital visit.

Types of pleural procedures

Thoracic ultrasound scan:
A Thoracic Ultrasound Scan is a bedside jelly scan of the chest (similar to ultrasound scans used with pregnant women) to check if there is any abnormal fluid accumulation in the pleural cavity (between chest wall and lung) and to mark the area prior to a pleural procedure.

Pleural aspiration:
A procedure involving passing a small needle under local anaesthetic, into the pleural cavity (between chest wall and lung) to remove abnormal accumulation of fluid or air. Pleural Aspiration procedures can be for diagnostic purposes (where 20-50mls fluid is taken and sent to lab for analysis) or for therapeutic purposes (where up to a litre of fluid could be removed to help breathing).

Chest drain:

A small plastic tube is inserted into the pleural cavity (between chest wall and lung) to drain abnormal accumulation of fluid or air in the pleural cavity. The tube is stitched onto skin and connected to a bottle. The drain can be in place for a few days to drain all the fluid or air.

BEFORE THE PROCEDURE:
• Please let us know if you are on any blood-thinning medications such as Aspirin / Clopidogrel / Warfarin / Apixaban / Rivaroxaban, etc.
• If you are taking Clopidogrel, Dipyridamole or Ticagrelor you must stop 5-7 days before the date of the procedure. (NB: Let us know if you have had a recent heart attack or stroke or minor stroke, in which case you may not be able to stop these medications.)
• Stop Warfarin 5 days before the procedure. (You will need an INR test 1 day before the procedure or on the day. It has to be less than 1.5 for us to safely do the procedure.)
• If you are taking Apixaban / Rivaroxaban / Dabigatran, you must stop 2 days before the procedure.
• Dalteparin / Heparin Injections must be stopped 1 day before the procedure.
• If you are taking Aspirin, you must stop on the day of the procedure.
• It is fine to drink and eat a light meal before the procedure.

ON THE DAY OF THE PROCEDURE:
• You will have a Thoracic Ultrasound first. The Doctor will let you know if s/he will go ahead with a diagnostic or therapeutic aspiration or a chest drain or no procedure.
• The Doctor will explain the procedure to you, again. You can ask any questions you may have. We will take a written consent.
• You may need admission to a Ward from the clinic if any complications occur during the procedure or if a chest drain is inserted.
• A Pleural Aspiration or a drain usually takes around 30 minutes.

COMPLICATIONS OF PLEURAL ASPIRATION / CHEST DRAIN PROCEDURES:
Pleural Aspiration is generally a safe procedure, however, as with all medical procedures, there are certain risks/complications (for example, local pain, bleeding, infection, lung puncture, faint attack).

Pain
The local anaesthetic will sting briefly, but the actual procedure itself should be painless. You may get some chest discomfort or cough if we need to take large amounts of fluid, which should settle down after a few minutes.

Infection
Rarely may infection develop at the site of procedure, which can usually be treated with antibiotics. Very rarely, this may need surgical procedure.

Bleeding
Rarely, there might be some bleeding into the pleural space, which usually settles without any treatment. Very rarely, this might need surgical intervention/operation if the bleeding does not stop.

Lung Puncture
There is a small risk of lung puncture, causing air leak into the pleural space and lung collapse. This usually is small and may not need any further intervention. If it happens, you may need to be admitted for observation and rarely might need a chest drain (a small plastic tube) insertion to drain the air.

AFTER THE PROCEDURE:
• You may need a chest x-ray to make sure there are no complications and to see how much air/fluid is still left.
• If there are no complications, and all observations are normal, you will be discharged home.
• We advise you should not go home on public transport after the procedure. We advise that a family member / friend drives you home or consider using a taxi.
• You will have a simple dressing at the site of the procedure, which can be removed next day.

Please feel free to contact us with any questions on the numbers below:

DEPARTMENT OF RESPIRATORY MEDICINE
Patient Pathway Co-Ordinator: 01908 997075 / 01908 996617
Central Booking Team: 01908 997050