P30 What difference does bedside ultrasound guidance make to pleural fluid aspiration and drainage in a district general hospital setting?

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Abstract

Background

British Thoracic Society guidelines strongly recommend thoracic ultrasound prior to all pleural procedures for pleural fluid. Previous studies have shown lower rates of failure and pneumothorax following the use of chest ultrasonography prior to pleural procedures.

Aim

We have set out to identify, in a district general hospital environment, the effect of pleural ultrasound on selection of sites for pleural procedures, the change in operator's confidence associated with those procedures and the reasons for changes in site selection.

Methods

47 patients with suspected pleural effusions had an aspiration or drainage site marked based on clinical findings, chest radiography and CT scan. Sites were then marked after bedside thoracic ultrasound examination by a member of the respiratory team (Level 1 competence). The level of confidence associated with obtaining fluid safely was assessed both before and after ultrasound on a visual analogue scale. The distance between sites marked before and after ultrasound and whether the procedure performed was the same as originally planned were also recorded.

Results

Following thoracic ultrasound no procedure was considered safe in 13% (6/47). A procedure was carried out in 87% (41/47). In 78% of these (32/41), the preferred site was changed after ultrasound. The reasons were greater fluid depth in 69% (22/32), an anticipated greater yield during therapeutic aspiration in 16% (5/32) and the initial site not being safe in 16% (5/32). Sites marked prior to ultrasound were considered unsafe in 23% (11/47) due to risk of pneumothorax in 15% (7/47) or the clinically marked site being below the diaphragm in 9% (4/47). Bedside chest ultrasound increased the confidence associated with pleural procedures. The confidence after ultrasound of the performed procedure was increased by 1.09 (95% CI 0.85–1.34) on the 5-point visual analogue scale.

Conclusions

Bedside chest ultrasound prior to pleural procedures in this cohort resulted in a change in the preferred site in a considerable number of patients. Ultrasound increased the level of confidence with the selected pleural procedures and resulted in a change to the intended procedure in 23% (11/47) of cases which included completely abandoning the procedure in 12.7% of cases (6/47).

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