• Kay Choong See, Venetia Ong, Chia Meng Teoh, Oon Cheong Ooi, Louis Sutrisno Widjaja, Sandhya Mujumdar, Jason Phua, Kay Leong Khoo, Pyng Lee, and Tow Keang Lim.
• Division of Respiratory and Critical Care Medicine, National University Health System, University Medicine Cluster, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
• Respirology. 2014 Apr 1;19(3):396-402.

Background And ObjectivePleural procedures such as tube thoracostomy and chest aspirations are commonly performed and carry potential risks of visceral organ injury, pneumothorax and bleeding. In this context limited information exists on the complication rates when non-pulmonologists perform ultrasound-guided bedside pleural procedures. Bedside pleural procedures in our university hospital were audited to compare complication rates between pulmonologists and non-pulmonologists.MethodsA combined safety approach using standardized training, pleural safety checklists and ultrasound-guidance was initially implemented in a ∼1000-bed academic medical centre. A prospective audit, over approximately 3.5 years, of all bedside pleural procedures excluding procedures done in operating theatres and radiological suites was then performed.ResultsOverall, 529 procedures (295 by pulmonologists; 234 by non-pulmonologists) for 443 patients were assessed. There were 16 (3.0%) procedure-related complications, all in separate patients. These included five iatrogenic pneumothoraces, four dry taps, four malpositioned chest tubes, two significant chest wall bleeds and one iatrogenic hemothorax. There were no differences in complication rates between pulmonologists and non-pulmonologists. Presence of chronic obstructive pulmonary disease (COPD) independently increased the risk of complications by nearly sevenfold.ConclusionsResults from this study support pleural procedural practice by both pulmonologists and non-pulmonologists in an academic medical centre setting. This is possible with a standard training program, pleural safety checklists and relatively high utilization rates of ultrasound guidance for pleural effusions. Nonetheless, additional vigilance is needed when patients with COPD undergo pleural procedures.© 2014 The Authors. Respirology © 2014 Asian Pacific Society of Respirology.

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