Pleural team

Who are we?

  • Mrs Sonni Andrew (Specialist Nurse)

  • Ms Jocelyn Roden (Specialist Nurse)

Who do we see?

  • We see patients with all forms of pleural disease e.g. unexplained pleural effusions, suspected pleural malignancy including mesothelioma, pneumothorax.

  • Tunnelled long term indwelling pleural catheters (TIPC) are also inserted for malignant pleural effusions.

How to refer a patient to the Pleural service?

For General Practitioners

  • SCI-store referral marked "FAO pleural service" (or similar), should suffice.

  • Your referral is triaged accordingly to us.

For colleagues within the hospital

  • In-patient review: See Rotawatch for our in-patient Respiratory referral email.

  • E-mail if referring Mon-Friday 0900-1700, unless a clinical emergency (if so, page the on call Respiratory Registrar).

  • Out-patient review: dictate a letter and ask your secretary to use the internal (electronic) referral system.

Location of clinic

Day of clinic

  • Wednesday morning

Chest X-ray noting a large left pleural effusion.

Here is a typical letter that you will receive if referred to our Pleural Clinic to get fluid removed from your chest. We call this a pleural tap or thoracocentesis:

Patient information for Aberdeen Royal Infirmary Pleural Clinic

1. You have been referred to the Respiratory Pleural clinic in Aberdeen as your chest x-ray has shown fluid around your lungs.

2. Your appointment details are attached in the accompanying letter.

3. If you are on blood thinning medication (warfarin, ticagrelor, rivaroxaban, apixaban), please contact Diane Mitchell (Respiratory secretary) on 01224 551214 for further instructions

Please bring an overnight bag as you may need to stay on the ward after tests. We suggest that you bring someone to drive you home.

4. What happens in clinic?

  • You will be assessed by a respiratory doctor

  • You may require an ultrasound scan/sonogram (similar to a baby scan or heart scan) of your chest

  • You may require drainage of the fluid and a biopsy of the lining of your lungs. This will be discussed with you at clinic.

  • The procedure is performed with local anaesthetic.

  • You will be asked to sign a consent form for the test.

  • You can usually go home afterwards.


5. What happens after the clinic or test?

  • You may need an x-ray after drainage or biopsy

  • If you are feeling well, you will be able to go home.

  • You may have a stitch inserted in your skin after the test.

  • Keep the area dry and book an appointment with your GP practice for 5-7 days to have the stitch removed.

  • The doctor will inform you of any follow up arrangements. The results from samples taken usually take 2-3 weeks.

Here is some information if you need, in addition to a pleural tap, pleural biopsies and / or a chest drain inserted.

The picture above shows a patient who has needed a drain, and you can see that the fluid drains into a special bottle, allowing the lung to re-inflate and thus breathlessness improves.

Patient information for Aberdeen Royal Infirmary Pleural Clinic

Pleural biopsy

  • In addition to removing fluid (called a pleural tap, as described earlier), it is also possible at the same visit to also take tiny samples of the lining of the lungs, called the pleural membranes. These samples are called biopsies.

  • Pleural biopsies are usually done to find the cause of a collection of fluid around the lung (pleural effusion) or other abnormality of the pleural lining.

  • After local anaesthesia, a sample of the pleura (lining) is taken using a special biopsy needle.

  • Your doctor will explain the procedure prior to it.

What is a chest drain?

  • A chest drain is a thin plastic tube that is inserted into the pleural cavity (space between lung and chest wall).

Why do you need a chest drain?

  • Because your Chest X-Ray has shown signs of fluid or infection or air in the pleural space that needs to be drained.

How is it inserted?

  • You will be assessed by a Respiratory doctor.

  • You may require an ultrasound scan/sonogram (involves applying gel on your chest and using a hand-held device to roll over your chest; similar to a baby scan or heart scan).

  • You will be asked to sit upright (figure on next page) or lie on your side.

  • After cleaning the skin, local anaesthetic will be given to numb the area.

  • You will feel some pressure and tugging but no pain.

  • A tube will be inserted with a suture to keep it in place.

  • The tube will get connected to a bottle to drain the fluid or air.

  • There may be some pain afterwards, but this will ease with analgesics (pain relief medication.)

Consent

  • You will be asked to sign a consent form prior to the procedures. The doctors will be able to answer any questions, if you have any.

Can anything go wrong?

  • There is a small risk of infection or bleeding but every effort is made to prevent this happening.

  • Sometimes air can leak out but this resolves in few days.

What happens after?

  • You may need an X-Ray after the procedure.

  • The doctor will inform you of any follow up arrangements.

  • The results from samples taken usually take 1-2 weeks.

Important things to let your doctor know

  • If you are on any blood thinning medication (eg. clopidogrel, warfarin, rivaroxaban, dalteparin, ticagrelor or apixaban), please let us know.

  • These may need to be stopped prior to the procedure.