Appropriate use of thoracic ultrasound (TUS) reduces the risk of iatrogenic complications from pleural procedures in comparison with unguided intervention(1). The ERS has introduced a TUS certification programme in order to improve thoracic ultrasound competency. 

This retrospective review compared ultrasound-guided thoracocentesis with non-ultrasound guided thoracocentesis in a level 3 hospital with regards to diagnostic yield and complication rate. Ultrasound-guided procedures were defined as being performed by trainees with ERS TUS certification. Thoracocentesis performed after being marked by radiology were defined as non-ultrasound guided. Chest radiograph was reviewed to determine pneumothorax rate. Lights criteria and pleural cytology were reviewed to determine diagnostic yield.

20 patients were reviewed; 10 who underwent thoracocentesis with TUS and 10 patients without TUS guidance. Pneumothorax occurred in 5 patients without TUS guidance compared with no occurrence when TUS was used. There was no occurrence of bleeding in either group. In the ultrasound group, pleural fluid was sent for light?s criteria and cytology in all cases. In the non-ultrasound group, pleural fluid was sent for light?s criteria in 70% of cases and cytology in 60%. 

This review highlights the importance of ultrasound competency training for trainees in reducing the risk of pneumothorax and improving the diagnostic yield for our patients.

1. McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. European Respiratory Review. 2019;28(154):190090.