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Pleural Services

Checked: 23-06-2023 by Vicky Ryan Next Review: 23-06-2025

Service Overview - NBT

The pleural service treats patients with pleural pathologies, including pleural effusions, pleural thickening and pneumothorax. We aim to manage patients in the out-patient setting whenever possible. We perform pleural aspirations within our clinics to minimise hospital attendances and to ensure patients symptoms are promptly investigated and managed.

Services we offer:

Full assessment and management of pleural effusion, including thoracic ultrasound and diagnostic or therapeutic pleural aspiration at the time of appointment if required
Day case indwelling pleural catheter (IPC) insertion, ultrasound guided pleural biopsy and thoracoscopy, performed on our weekly pleural procedure list.
Out-patient talc pleurodesis via IPCs.
Access to NIHR clinical trials – currently we have the largest pleural trial portfolio in UK.
Expert investigation and compensation advice on all asbestos related conditions.
Management of mesothelioma, including access to clinical trials via our specialist clinic.

If you have any queries regarding the service or referral pathways, please contact Anna Morley (pleural clinical nurse specialist) on 0117 414 1900 or Louise Brennan (secretary to Prof. Maskell, Dr McDill and Dr. Clive) louise.brennan@nbt.nhs.uk Tel: 0117 414 2016

Referral Guidance - NBT

Any patient with symptomatic unilateral pleural effusion where an intervention will avoid hospital admission or allow fast track investigations into the underlying cause. These clinics are unsuitable for patients who are acutely unwell or bedbound.

Please include anti coagulation and anti-platelet information in any correspondence as this may influence the timing of interventions.

Urgency	Admission avoidance	2WW referral	Routine referral
Referral Criteria	Breathless with unilateral pleural effusion	Chest x-ray suspicious of mesothelioma or lung cancer (eg new unilateral effusion)	Undiagnosed pleural effusions Pleural thickening Asbestos related disease
Referral method	Referrals should be emailed to: Nbn-tr.pleuralservice@nhs.net	Using suspected lung cancer (2WW) referral form	e-referral via ‘Pleural RAS’
Timing of appointment	Hot clinics run Mon, Tue, Thur & Fri	Aim to see within 10 days of referral	Routine clinic review (usually within 4 weeks)

Service Overview - UHBW

When

Tuesday afternoons and Friday

Where

Respiratory department, Location A221, Bristol Royal Infirmary.

Inclusion criteria

Any adult patient with pleural disease that needs investigating. This includes pleural effusions, pneumothorax follow-up and pleural thickening.

NB: The clinic is set up to perform diagnostic pleural taps and therapeutic pleural aspirations. Any patient requiring a procedure must be physically capable of sitting on edge of trolley independently whilst procedure is performed

Exclusion criteria

Patients who are systemically unwell.

Referral Guidance - UHBW

Refer using the Pleural Clinic Referral Form (word doc).

Email referral form to: PleuralReferralsUHB@UHBW.nhs.uk

For enquiries please telephone 0117 3424101.

The clinics are every Tuesday afternoon and Friday. We triage all referrals and book into the soonest clinic available. Priority will be given to those who need symptomatic relief to avoid admission and patients referred in the 2 week wait category. If you wish to discuss the referral please call 0117 3424101.

Please ensure patient contact telephone number is included.
Please attach a copy of the patient’s recent medications and relevant medical history.
If attending from ED, please ensure a copy of the ED notes are attached.

If referring patients for a procedure please ensure they are aware of this and that they may be in the department for some time

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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