Direct ultrasound localisation for pleural aspiration: translating evidence into action

Intern Med J. 2014 Jan;44(1):50-6. doi: 10.1111/imj.12290.


Background: There is strong evidence that direct ultrasound localisation for pleural aspiration reduces complications, but this practice is not universal in Australia and New Zealand.

Aims: To describe the current utilisation and logistical barriers to the use of direct ultrasound localisation for pleural aspiration by respiratory physicians from Australia and New Zealand, and to determine the cost benefits of procuring equipment and training resources in chest ultrasound.

Methods: We surveyed all adult respiratory physician members of the Thoracic Society of Australia and New Zealand regarding their use of direct ultrasound localisation for pleural aspiration. We performed a cost-benefit analysis for acquiring bedside ultrasound equipment and estimated the capacity of available ultrasound training.

Results: One hundred and forty-six of 275 respiratory physicians responded (53% response). One-third (33.6%) of respondents do not undertake direct ultrasound localisation. Lack of training/expertise (44.6%) and lack of access to ultrasound equipment (41%) were the most frequently reported barriers to performing direct ultrasound localisation. An average delay of 2 or more days to obtain an ultrasound performed in radiology was reported in 42.7% of respondents. Decision-tree analysis demonstrated that clinician-performed direct ultrasound localisation for pleural aspiration is cost-beneficial, with recovery of initial capital expenditure within 6 months. Ultrasound training infrastructure is already available to up-skill all respiratory physicians within 2 years and is cost-neutral.

Conclusion: Many respiratory physicians have not adopted direct ultrasound localisation for pleural aspiration because they lack equipment and expertise. However, purchase of ultrasound equipment is cost-beneficial, and there is already sufficient capacity to deliver accredited ultrasound training through existing services.

Keywords: decision tree; paracentesis; pleural disease; pleural effusion; ultrasonography.

MeSH terms

  • Australasia
  • Biopsy, Needle / economics
  • Biopsy, Needle / methods*
  • Cost-Benefit Analysis
  • Data Collection
  • Decision Trees
  • Durable Medical Equipment / economics
  • Durable Medical Equipment / supply & distribution
  • Education, Medical, Continuing
  • Health Expenditures
  • Health Services Accessibility
  • Humans
  • Pleural Effusion / diagnosis
  • Pleural Effusion / pathology*
  • Point-of-Care Systems / economics
  • Point-of-Care Systems / statistics & numerical data
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Professional Practice / classification
  • Pulmonary Medicine / economics
  • Pulmonary Medicine / education
  • Pulmonary Medicine / instrumentation
  • Pulmonary Medicine / methods*
  • Ultrasonography, Interventional* / economics
  • Ultrasonography, Interventional* / instrumentation
  • Ultrasonography, Interventional* / statistics & numerical data