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Date issued: August 2022

Review date: August 2024

Ref: B-456 v2  pleural biopsy final August 2022 v2.pdf [pdf] 290KB

Pleural biopsy Information for patients

Provisional appointment date & time:                ________________________________

Your responsible (lead) consultant is:                ________________________________

Important information about your procedure

• Please report to __________________ ward with this information leaflet on the date and time above. Please ensure you leave enough time for your journey to the hospital.

• Please tell the doctors and nurses looking after you about any medical conditions you have, and all the medication you take.

• Please tell us if you take any medication to thin the blood: these may need to be stopped before your procedure. You must continue to take any other medication as normal.

• If you have been told by your doctor that you may be able to go home the same day after your procedure, please ensure someone is able to bring you into and take you home from the hospital.

• Please seek medical advice if you develop any shortness of breath or increasing chest pain at home after your procedure.

Please sign and date below to confirm that you have read this information leaflet in full. You will have the opportunity to discuss any questions you might have about the procedure, or any other aspects of your treatment, with a doctor when you come to hospital for your appointment.

Signature:  __________________________________________________

Print name: __________________________________________________

Date: __________________________________________________

What is a pleural biopsy?

The pleura is a thin skin that lines the inside of your chest cavity. Some patients have thickening of this lining and require a biopsy to help identify the cause of this thickening. Your doctor can take a sample of the pleura, using local anaesthetic to numb the surface of the chest wall. A needle can then be targeted, using an ultrasound machine, to take a small snip of tissue (a biopsy) from the pleura. Your doctor may take several biopsies to give you the best chance of a diagnosis. We then analyse this sample in the lab.

Why do I need a pleural biopsy? Are there alternative tests available?

Your doctor has recommended a pleural biopsy as the best way of finding out what is causing your illness and therefore guide future treatments. Your doctor will have considered this carefully, and made their decision with your best interests in mind. However, it is ultimately your decision as to whether or not you wish to have the procedure done.

Some patients may undergo thoracoscopy to obtain biopsies of the lining of the chest cavity. This procedure can be done under local anaesthetic or a general anaesthetic but is a more invasive, surgical procedure and so is usually only considered if an ultrasound guided biopsy is not possible. Your doctor can discuss this with you further if required.

Because of the many causes of thickening of the pleura, some patients may prefer a ‘watch and wait’ approach where your doctor would follow you up with subsequent imaging. However, this can cause delays in your diagnosis which may in turn, limit your treatment options down the line.

If you have any concerns or questions, please let your doctor know and they will be happy to discuss things with you in more detail.

How should I prepare for my pleural biopsy?

• Please make sure we have your correct telephone number(s) as we may need to call you a few days before your procedure to confirm arrangements and that you are still able to come to hospital. If we are unable to contact you, we may offer your appointment to another patient who is waiting for this procedure.

• Please let us know in advance if you are:

  • Pregnant

  • Taking medication to thin your blood

If any of these apply to you, we will need to make special arrangements for your procedure. These may include instructions as to what you should do with your medication.

• Please bring the following items with you on the day of your procedure:

  • all your medications (we need to know what you are taking, including prescription and “over the counter” treatment)

  • reading glasses, if you need them

What should I do with my medications?

It is important to let us know in advance if you are taking medication to thin the blood. These will need to be stopped temporarily before your procedure can go ahead. Your procedure may need to be cancelled if you do not follow these instructions.

Please take your other medication as normal

The tables below explain what you should do with your medication in more detail. Please contact your doctor if you are not sure what to do. If your blood thinning medication cannot be stopped then your doctor may change it to an alternative medication temporarily, to enable the procedure to take place.

Blood thinning medications

Medication                                Instructions

Warfarin                                     Stop 7 full days before your procedure. You will need to have an INR blood test with your GP or at the hospital 1-2 days before                                                         your procedure to make sure your INR is less than 1.5; otherwise we may need to cancel your procedure.       

 

Aspirin                                          Stop 1 full day before your procedure.

 

Clopidogrel (Plavix)               

Dipyridamole (Persantin)           Stop 7 full days before your procedure.

Ticagrelor (Brilique)   

 

Apixaban (Eliquis)

Dabigatran (Pradaxa)

Edoxaban (Savaysa)                 Stop 2 full days before your procedure.

Rivaroxaban (Xarelto)

 

Dalteparin (Fragmin)

Enoxaparin (Clexane)                 Stop 1 full day before your procedure.  

Tinzaparin (Innohep)

 

What will happen on the day of my procedure?

Please report to the ward at the time of your appointment. You will be contacted by the team to inform you of the precise time and location of your procedure in advance. You will be greeted by a member of the team who will check your observations (e.g., heart rate, blood pressure, temperature) and go through a checklist with you. This will include questions about your medical history, medications, and allergies.

A member of the team may take some blood tests if these have not been checked in advance. The procedure will be explained to you in more detail, and you will be asked to sign a consent form to confirm you are happy to go ahead.

A doctor will do an ultrasound scan of your chest to help decide where to sample the pleura. This involves placing gel and a hand-held probe over your skin to create a picture on a screen. The ultrasound scan should not be painful. The doctor will then inject local anaesthetic into your chest wall; this may sting at first, but will soon numb the area so you do not feel anything during the procedure.

Once the area is numb, the doctor will be able to insert a needle into the pleura to take a sample. The needle used to take the biopsy has a rounded tip so a small cut in the skin will be made to enable the needle to insert smoothly. There is rarely a need for a stitch. Your doctor may take multiple samples from this site to optimise the chance of a diagnostic sample. After the sample is taken, a plaster will be placed over the site.

The pleural biopsy usually lasts between 40 and 60 minutes.

What are the risks of the procedure?

Pleural biopsy is generally a very safe procedure, and serious complications are rare.

• Pain

You will experience pain in association with the procedure, but this is rarely severe. There is likely to be discomfort associated with the local anaesthetic and after the procedure the site may feel bruised. It is normal for your chest to be sore for a week or so after your procedure; this can be managed with painkillers.

• Infection

There is a low but important risk of infection following a pleural biopsy. This can usually be treated with antibiotics, although it may sometimes need a chest drain to be inserted (a small tube) to empty the chest cavity of any infected fluid and therefore, can result in a hospital stay. Very rarely, infections can be more serious and need surgical treatment (an operation). Your doctor will take precautions during the procedure to ensure that this risk is minimised.

• Bleeding

A small amount of bleeding at the site of the procedure is normal. However, a small amount of people have significant bleeding during their procedure. This can usually be managed at the time of the procedure, but very rarely surgical treatment (an operation) is required.

• Pneumothorax

Your doctor will use an ultrasound scanner to locate the pleura for the procedure. However, there is a risk that the needle used to take a sample of the pleura, punctures the lung, causing it to collapse down. This is called a pneumothorax. Usually this doesn’t need any treatment but <5% will require insertion of a chest drainage tube to allow the lung to re-expand. This will require a hospital stay. Usually, this air leak will settle on its own but rarely, it needs a surgical procedure.

What happens after the procedure?

The team will arrange for you to have a chest x-ray. If you are in any discomfort, we will give you painkillers to manage this. You must let your nurse and/or doctor know if your chest becomes increasingly painful or you feel increasingly short of breath. An air leak after the biopsy may not be detected on the initial post procedure chest x-ray and so a second chest x-ray, 3 hours after the first, may be required. If you feel well and your chest x-rays are ok you will be allowed to go home. You can estimate to be in hospital for up to 5 hours for the procedure and subsequent chest- x-rays to take place.

When will the results of my procedure be available?

It will take 1-2 weeks for the results of your pleural biopsy to be ready. This is because it takes time for the specimens to be analysed. You will be given an appointment in the Chest Clinic to discuss the results with a doctor about 2 weeks after your procedure. Please contact your lead consultant’s secretary one week after your procedure if you have not received an appointment for the Chest Clinic.

How do I contact you?

If you have any questions or concerns, please contact:

Pleural Secretary:

Tel: (01752) 431496

Respiratory Fast Track Coordinators

Tel: 01752 763863

In the event of an emergency, please contact your on-call GP or NHS 111 for further advice