This leaflet will help explain what will happen during your consultation in pleural clinic and hopefully answer any questions you may have.
Before your appointment.
You should receive a clinic appointment by telephone or letter. Our clinic is held on ward 10 at Blackpool Victoria Hospital which is located in area 5.
You are welcome to bring one relative, close friend or carer with you to your appointment. You can request a chaperone during examination or procedures.
We suggest that you wear comfortable clothing on your upper half that is easy to remove, as it is likely that you will have a clinical examination during your appointment. Please read the patient information leaflets below for more information on how to prepare for your appointment. It is especially important that you read these if you are taking blood-thinning medications.
Please remember to check your appointment letter for anything specific you have been asked to take with you. In addition, it would be helpful if you could bring the following:
• a list of your medications,
• your reading glasses if you need them.
Medications.
It is important that we know in advance if you are taking blood thinning medications as these may be stopped temporarily before the appointment. This should be discussed with your consultant prior to your appointment.
The table below explains what to do with these medications. If you are on any of these medications, please inform your consultant prior to your appointment.
| Medication | Omit medication duration | Restart medication |
|---|---|---|
| Warfarin | 5 days before and INR check the day of appointment or day before | 12 hours after |
| Edoxaban (Lixiana) | 48 hours before | 12 hours after |
| Rivaroxaban (Xarelto) | 48 hours before | 12 hours after |
| Apixaban (Eliquis) | 48 hours before | 12 hours after |
| Clopidogrel | 7 days before | 12 hours after |
| Ticagrelor (Brilique) | 5 days before | 12 hours after |
| Therapeutic LMWH (dalteparin, fragmin) | 24 hours before | 12 hours after |
During your appointment
Your appointment or procedure may take between 30 minutes to a couple of hours.
Blackpool Teaching Hospital NHS Foundation Trust is involved in medical staff training so there are student & trainee doctors and nurses present in the clinic. They learn a great deal from talking to and examining patients and your cooperation is greatly appreciated. However, your right to refuse the presence of students will be respected and such a refusal will not affect the standard of care you receive.
At your clinic appointment, your observations will be checked on arrival and we will then undertake a clinical assessment. We will also perform a thoracic ultrasound, which is a non-invasive scan but does involve putting some cold jelly on your chest.
Please read the patient information leaflets below for more information about what to expect during your procedure
Most of our patients are referred into pleural clinic for an assessment or the management of a pleural effusion.
A pleural effusion is a condition affecting the lining of the lung (pleura). Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.
Your pleura is a large, thin sheet of tissue that wraps around your lungs and lines the inside of your chest wall. Between the two layers is a very thin space that is normally filled with a small amount of fluid.
Occasionally this pleural space can fill with air (pneumothorax), fluid (effusion), infection, pus (empyema) and/or blood (haemothorax). There are many conditions that can cause this to happen
To help with your diagnosis or to help manage your symptoms, a pleural aspiration or drainage using ultrasound guidance may be carried out during your appointment.
This is a procedure which is usually well tolerated. Aseptic precautions will be used throughout the procedure and involves a small needle which is inserted into the pleural space to take a small amount of fluid.
This fluid is sent to our laboratory to help with diagnosis and help decide the best way of treating it. It can also be used as a form of treatment and is done by numbing the skin using local anaesthetic. We will then drain away some fluid to help manage symptoms. We are able to drain a maximum of 1.5 litres per procedure.
Pleural aspirations are generally well tolerated procedures with serious complications being rare, however with all medical procedures, there are some risks:
• Pain – Local anaesthetic will be given for therapeutic aspirations which numb the skin and to help with any pain the procedure may cause. However, you may feel a sharp scratch while instilling the local anaesthetic. During large amounts of fluid removal, you may experience some chest discomfort and cough, but this usually settles after a few minutes. The drainage can be paused if needed. After the procedure, your chest may feel a little sore and mild painkillers are recommended for this.
• Infection – rarely an infection can occur at the procedure site. This can usually be treated with antibiotics.
• Bleeding – rarely the procedure can cause bleeding into the pleural space. This often settles without any further procedures however it may require a chest drain insertion or operation.
• Lung damage – There is a small risk of lung damage which could cause air leak into the space around the lung. This doesn’t usually require treatment, however sometimes you may need to be admitted to hospital for insertion of a chest drain.
After the pleural aspiration we will monitor you for a further 30 minutes in our recovery area and we will repeat your observations, you may also require a chest x-ray.
After this time, if you are well, you will be able to leave the clinic. If samples have been sent following the procedure, the results can take up to a week to be analysed. You may receive a follow up appointment in the pleural clinic or followed up by the physician who referred you into the clinic to discuss your results.
Sometimes a pleural aspiration will not establish a firm diagnosis and further investigations are required, this will be discussed with you.
Other investigations.
We also carry out many other investigations at our pleural clinic. You may be attending the clinic for an assessment of a pneumothorax (air between your lung linings), or a diaphragm assessment.
Your consultant will discuss the investigation process with you for these at your appointment.
