Shaping better health
REMEDY : BNSSG referral pathways

Pleural Services

Checked: 27-11-2018 by vicky.ryan Next Review: 27-11-2019

Service Overview - NBT

Extra capacity has been added to the admission avoidance pleural service (Nov 2018). Recent audit data shows that 96% of patients are able to be managed totally in the out-patient setting.  We perform pleural aspirations within our clinics to minimise hospital attendances and to ensure patients symptoms are promptly investigated and managed.

Services we offer:

  •  Full assessment and management of pleural effusion, including thoracic ultrasound and diagnostic or therapeutic pleural aspiration at the time of appointment if required
  •  Day case indwelling pleural catheter (IPC) insertion and thoracoscopy, performed on our weekly pleural procedure list.
  •  Out-patient talc pleurodesis via IPCs.
  •  Access to NIHR clinical trials – currently we have the largest pleural trial portfolio in UK.
  •  Expert investigation and compensation advice on all asbestos related conditions.
  •  Management of mesothelioma, including access to clinical trials via our specialist clinic.

If you have any queries regarding the service or referral pathways, please contact Louise Brennan (secretary to Prof. Maskell and Dr. Clive):   Tel: 01174146451


Referral Guidance - NBT

Any patient with symptomatic unilateral pleural effusion where an intervention will avoid hospital admission or allow fast track investigations into the underlying cause. These clinics are unsuitable for patients who are acutely unwell or bedbound.

Please include anti coagulation information in any correspondence as this may influence the timing of interventions.


Admission avoidance

2WW referral

Routine referral

Referral Criteria

Breathless with unilateral pleural effusion


Chest x-ray suspicious of mesothelioma or lung cancer (eg new unilateral effusion)

  • Undiagnosed pleural effusions
  • Pleural thickening
  • Asbestos related disease

Referral method

Please e mail referral to:

Using suspected lung cancer (2WW) referral form

e-referral via ‘Pleural eRAS’

Timing of appointment

Hot clinics run Mon, Tue, Thurs and Fri


Aim to see within 10 days of referral

Routine clinic review (usually within 4 weeks)


Service Overview - UHB

The clinic is set up to prevent admission of patients with pleural effusions and other pleural diseases.

Whilst the majority of patients are expected to have pleural effusions, the clinic is for patients with all forms of pleural disease such as pneumothraces, pleural thickening, etc. The time slots are flexible and allow us to perform diagnostic and therapeutic aspirations which previously required admission.

The clinic is every Wednesday morning. We will endeavour to see all patients the Wednesday after they are referred with the deadline being Tuesday 13:00 unless discussed with the consultant in charge.  If the clinic is full, priority will be given to those who need symptomatic relief to avoid admission and patients referred in the 2 week wait category.

Please ensure that the patient contact telephone number is included on the form. We will contact them by phone to give an appointment time.

If referring patients for a procedure please ensure that they are aware of this and that they may be in the department for some time.

Referral Guidance - UHB

Refer using the Pleural Clinic Referral Form (word doc).  Referrals should be faxed to 0117 342 2921

Inclusion Criteria:

  • Any adult patient with pleural disease that needs investigating.  This includes pleural effusions, pneumothorax follow-up, pleural thickening.

NB:  The clinic is set up to perform diagnostic pleural taps and therapeutic pleural aspirations.  Any patient requiring a procedure must be physically capable of sitting on edge of trolley independently whilst procedure is performed.

Exclusion Criteria:

  • Patients who are systemically unwell

For Advice - The Respiratory Nurse Specialists can be contacted on 0117 342 4101