British Thoracic Society Clinical Statement on pleural procedures

Abstract

Introduction A total of 21 659 pleural aspirations or drain insertions were conducted in England in 2019/2020 with a combined cost of £13.4 million.1 There are now a variety of different pleural procedures, which have different invasiveness, risks and benefits, and an abundance of data driving high-quality practice in interventional pleural practice. In the context of a number of national safety alerts related to pleural procedures in the last 10 years, it is therefore important that clinicians are as up to date as possible in interventional practice. This statement is intended to sit in parallel with the BTS Guideline for Pleural Disease 2023,2 and with a particular focus on pleural interventions in adults. The statement provides a narrative review of areas not covered in the main guideline. The main statement focuses on important areas of safe clinical practice, patient selection, evidence for complication rates, the consent process and troubleshooting guidance in the following areas: Safety and preparation for pleural procedures. Pleural aspiration (diagnostic and therapeutic). Intercostal drain insertion. Indwelling pleural catheter (IPC) insertion, management and removal. Image-guided pleural biopsy. Medical thoracoscopy.