Pleural Medicine Unit

For Patients and Visitors

Pleural Medicine Unit

What is the Service?

The Pleural Medicine Unit provides both inpatient and outpatient assessment and management of patients with pleural conditions. This service incorporates the Specialist Ambulatory Pleural Service (SAPS) and is coordinated by the Department of Respiratory Medicine.

The Pleural Medicine Unit is attended by a Pleural Physician, a Pleural Fellow and a Pleural Clinical Nurse Consultant.

What are Pleural Diseases?

Pleural diseases are problems that occur within the chest cavity, between the lung and the chest wall. The lung and the chest wall are lined with a thin membrane called the pleura. There are more than 50 known causes of pleural diseases, leading to accumulation of fluid (a pleural effusion) and/or air (pneumothorax). The Pleural Medicine Unit offers expert opinion and management of pleural diseases.

What can I expect from this service?

If you are an inpatient at Northern Health and are referred to our service, you can expect a prompt review by one of our team and a diagnostic ultrasound within 24 hours. We will provide an expert opinion to both yourself and your treating team, and if necessary, perform any procedures required for your care. We also have excellent links to the Northern Health Thoracic Surgical Service.

The Pleural Medicine Unit also provides a Specialist Ambulatory Pleural Service. The Specialist Ambulatory Pleural Service provides outpatient assessment, diagnosis and management for patients with pleural diseases. The Specialist Ambulatory Pleural Service runs a dedicated clinic once a week, and has a walk-in clinic during business hours, five days a week.

Patients referred to the Specialist Ambulatory Pleural Service can expect:

  • Contact from the Pleural Clinical Nurse Consultant via either telephone/text or letter, to confirm receipt of your referral and to advise if any additional tests may be required prior to your appointment in the Pleural Clinic.
  • The ability for rapid review in clinic by the Pleural Medicine Unit.
  • Expert opinion and advice about your symptoms and the potential cause.
  • Continued support from the Pleural Clinical Nurse Consultant throughout your journey.
  • Regular letters to update your GP and/or referring specialist
  • Dedicated interpreter service if needed.

How to access this service?

As an inpatient, your team will need to refer you to our service.
As an outpatient, you need a referral from your GP or medical practitioner.

  • Your GP will fax your referral to the hospital. Once we have received the referral, we will give you a phone call and/or send you a letter to confirm the date and location of your appointment.
  • Referrals are current for 12 months from the date of issue. Keep a copy of your referral, so you can easily ask your GP to renew your referral if you need to.

What do I bring/need for my appointment?

If you are an outpatient, you should bring to your first appointment:

  • A list of current medications
  • Blood test results
  • CT scans and chest x-rays
  • GP contact details, including address and phone number.

What are the potential outcomes of my appointment?

We almost always need to do further tests to confirm or provide a diagnosis for the cause of your symptoms. Further tests could include scans or blood tests. Sometimes more specialised tests may be required. Some of these tests may require you to stay in hospital for a short period of time. Specialised tests may include:

Thoracic Ultrasound

A thoracic ultrasound is an ultrasound of your chest – it uses sound waves to create pictures of your internal organs. It does not involve any radiation, and is completely harmless. A gel is applied to your chest to allow us to get a good image.

Thoracic ultrasound allows us to look for abnormalities of the pleura as well as identifying if there is fluid within the cavity. It also helps us make any invasive procedures that may be required safer (see below).

Typically you will have a thoracic ultrasound the first time you come to the pleural clinic, as well as on subsequent visits to monitor your progress.

Pleural Aspirate/Thoracentesis

If there is fluid in the chest, a procedure may need to be performed to sample the fluid, so that it can be tested. This helps us to work out what may be causing the buildup of fluid. You will need to be admitted to hospital for the procedure, usually just for one night. This is done with local anaesthetic in a sitting position. A small tube is put into the chest, between the ribs and fluid is drawn out. The tube can also allow us to take large quantities of fluid out to help relieve symptoms like shortness of breath.

Pleural Biopsy

Sometimes we need to get a small sample of the lining around the chest wall, the pleura, to help us to determine the cause of the pleural disease and how best to provide treatment for you. This can be done in a number of ways, often with the help of an ultrasound machine or a CT-scanner. Depending on the method, you will need to be admitted to the hospital, usually just for one night. Generally, you will be given local anaesthetic for the procedure as well as light sedation, to make you comfortable. In some situations, an operation by a surgeon may be required to obtain a sample of the pleura.

Indwelling Pleural Catheter

The pleural space is a space between the outer lining of the lung and the inner lining of the chest wall. Sometimes fluid can build up in the space, affecting the function of your lungs, making it more difficult to breathe. Indwelling pleural catheters are small tubes that can be inserted into the pleural space to drain away fluid that might be building up there. This catheter can stay in place for as long as needed, so that fluid can be drained easily, helping to avoid further procedures. Draining this fluid away usually helps to relieve shortness of breath. If you require this tube, you and your family are supported to drain the fluid at home and are able to contact the Pleural Service at any time for help and support.

Resources and patient information

Information for patients and families

Indwelling Pleural Catheter
Chest Drain Insertion
Pleural Clinic
Pleurodesis
Ultrasound Pleural Biopsy
Thoracentesis
T-PA

Contact us

Please contact the Pleural Clinical Nurse Consultant for:

  • enquiries about your referral
  • support with your indwelling pleural catheters and drainages
  • confirm or reschedule your Pleural Clinic appointment

Kirstin Tirant
Mobile: 0428 167 972
Email: Kirstin.tirant@nh.org.au

For Health Professionals

Service Overview

The Pleural Medicine Unit is an adult inpatient and outpatient service dedicated to the urgent assessment and management of patients with pleural diseases. This service incorporates the Specialist Ambulatory Pleural Service (SAPS) and is coordinated by the Department of Respiratory Medicine.

Inpatients referred to the Pleural Medicine service can expect:

  • Prompt review and assessment by a member of the Pleural Medicine team who will provide an expert sub-specialty opinion
  • Diagnostic ultrasound within 24 hours of referral
  • Pleural procedures if required, include:
    • Diagnostic and therapeutic aspirate
    • Pleural catheter insertion and subsequent management
    • Pleural biopsy
    • Intra-pleural therapy
    • Sclerosant pleurodesis
    • Tunneled-pleural-catheter, with ongoing community support

Outpatients referred to the Specialist Ambulatory Pleural Service can expect:

  • Close contact and coordination of patient care via our Pleural Clinical Nurse Consultant
  • The ability for rapid clinic review by a member of the Pleural Medicine team.
  • All previously mentioned pleural procedures if required
  • Access to any additional services provided by the Respiratory Medicine department if required.

The necessary tests and investigations will be organised prior to the patient being reviewed in the clinic, which will ensure that all essential information is available to the physician on the first appointment. When the patient is linked to the clinic, they will be contacted by the Pleural Clinical Nurse Consultant, who will then become their first point of contact for any urgent queries.

How to Refer

Urgent and complex referrals can be discussed with the Respiratory Registrar by calling Northern Health switchboard Tel: 8405 8000.

Acutely unwell patients should be directed to the nearest Emergency Department.

GP referrals: Use HealthLink to send referrals, including results and reports. For more information click here

Other health services (hospitals, allied health, specialists etc): Fax your referral to 8405 8616

Respiratory & Sleep Medicine Referral Guidelines (for adults) – click here

Referrals must include

  • Patient details including address, date of birth, Medicare number and contact phone number
  • Reason for referral
  • Relevant clinical history for the patient including medications and any allergies
  • Relevant investigation results including any pathology, Chest X-rays and/or CT Chest.
  • GP contact and provider number details.

Our Research

The Pleural Service is involved with multi-centre cutting-edge trials helping to expand the knowledge and management of pleural disease. We are involved in randomized trials and observational studies.

You may be asked to participate in research as part of your treatment, but this is always entirely your choice once it has been explained to you, and your decision to participate will not affect the quality or timing of your care

Examples of current trial involvement include:

  • The AMPLE-3 trial
    • A multi-centre trial comparing indwelling pleural catheters versus video assisted thoracic surgery for pleural effusions due to cancer.
  • The STOPPE trial
    • A multi-centre trial looking into the effectiveness of corticosteroids for pleural infections in addition to standard care.
  • The AIR trial,
    • a multi-centre trial evaluating the artificial creation of an air-pleural interface to improve CT acquisition of pleural nodules.
  • Fibrinolytic activity of intrapleural Alteplase in pleural infection
    • This is a multi-centre trial to examine the effect of intra-pleural tPA on systemic fibrinolytic activity in patients with complex pleural infection.

Professional Development

Pleural Fellowship
The Respiratory Department at Northern Health offers a, 12-month fellowship in Pleural Medicine.
For further details about a 12-month fellowship with the Pleural Service, please contact:
Sanjeevan.muruganandan@nh.org.au
Katharine.see@nh.org.au

Thoracic Ultrasound Course
The Pleural Medicine Unit runs a bi-annual, 1-day course on Thoracic Ultrasound. The course is ASUM accredited for CCPU lung and pleural modules. In addition to the theoretical aspects of thoracic ultrasound, the course involves hands-on scanning with patients with actual pathology as well as pleural-procedures on simulation models.

Nursing Education

  • Respiratory STEP (supported transition to excellence in practice) program
    • For more information please click here or here.
  • Learning packages
    • Under development, please check back here soon
  • Pleural catheters and drainage devices
    • Please feel free to contact the Pleural Clinical Nurse Consultant for any support and/or education for the management of all pleural catheters/chest tubes and drainage devices

Our Team

Director/Head of Unit
Dr Katharine See
MBBS FRACP MBA

Pleural Lead
Dr Sanjeevan Muruganandan
MBBS FRACP CCPU PhD

Pleural Fellow
Dr. Jayne Roberts
MBBS

Pleural Clinical Nurse Consultant
Ms Kirstin Tirant
RN 1, Grad Cert Cardiothoracics & Higher Education

Enquiries

Urgent outpatient referrals can be discussed by calling switch on 8405 8000 and requesting the Respiratory Registrar.
Inpatient referrals should be directed to the Pleural Fellow via paging system.

All other queries can be directed to the Pleural Clinical Nurse Consultant on 0428 167 972.