Clinical Nurse Specialist Led Image Guided Pleural Interventions - Is it Safe?
Background: Thoracic ultrasound (TU) guided procedures by Respiratory Physicians have shown similar safety and diagnostic accuracy to interventional radiologists. There are no data on clinical nurse specialist (CNS) undertaking different TU guided pleural procedures.
Objective: To evaluate the safety of TU guided pleural interventions by a Pleural CNS.
Methods: Activity level and Safety of interventions undertaken by CNS at Guys and St. Thomas NHS Foundation Trust from January–December 2014 were collected. A stepwise pragmatic approach of assessment was used. Intervention site was checked by a Pleural Physician. Data collected were dry tap, pain, infection, bleeding, inappropriate drainage and technique.
Results: Total procedures-outpatients Vs inpatients-54 Vs 41. Procedures undertaken were, aspirations (diagnostic and therapeutic)–58, indwelling pleural catheters–23, and seldinger drains-14. Site was identified correctly in 100% of the cases. The complication rate was 2%. 1) Pain following indwelling pleural catheter - from diaphragmatic irritation, 2) Vasovagal syncope during a diagnostic aspiration. No other defined complications were recorded.
Discussion: CNS underwent a period of observations and training in TU and procedures. Small effusions upto 2.0cm depth on ultrasound were aspirated. The complication rate is comparable to published literature.
Conclusion: This model could have significant impact on patient care and healthcare resource. To the best of our knowledge this is the first report of an CNS undertaking image guided complex pleural interventions.