Intercostal vessel screening prior to pleural interventions by the respiratory physician: a prospective study of real world practice

Abstract

Introduction The rising incidence of pleural disease is seeing an international growth of pleural services with physicians performing ever-increasing volumes of pleural intervention. This is frequently conducted on sites without immediate access to thoracic surgery or interventional radiology. Serious complications, such as pleural bleeding, are likely to be under-reported. Aim To assess whether intercostal vessel screening can be performed by respiratory physicians at time of pleural intervention as an additional step that could potentially enhance safe practice. Methods This was a prospective, observational study of 596 ultrasound-guided pleural procedures conducted by respiratory physicians and trainees in a tertiary centre. Operators did not have additional formal radiology training. Intercostal vessel screening was performed using a low frequency probe and the colour Doppler feature. Results The intercostal vessels were screened in 95% of procedures and the intercostal artery was successfully identified in 53%. Screening resulted in an overall site alteration rate of 16% in all procedures, which increased to 30% when the intercostal artery was successfully identified. This resulted in procedure abandonment in 2% of cases due to absence of a suitable entry site. Intercostal vessel screening was shown to be of particular value in the context of image-guided pleural biopsy. Conclusion Intercostal vessel screening is a simple and potentially important additional step that can be performed by respiratory physicians at the time of pleural intervention without advanced ultrasound expertise. Whether the widespread use of this technique can improve safety requires further evaluation in a multi-centre setting with a robust prospective study.