Pleural and peritoneal work in the COVID-19 era in a north-east hospital
Editor – Northumbria Healthcare NHS Foundation Trust runs a successful pleural and peritoneal service for patients with malignant pleural and peritoneal malignant fluid, pleural infection and pneumothorax.1–4 Most of the work is done through medical ambulatory care or semi-elective theatre work. All patient records referred from 16 March 2020 to 17 June 2020 were reviewed. Inclusion criteria were those patients who required an interventional procedure and managed on an outpatient basis. Basic demographics, diagnoses and mode of diagnosis and performed investigations were collected. A descriptive analysis of the data was performed.
Four patients with pneumothoraces were seen (all secondary pneumothoraces). The mean age was 57.5 years, two were treated with a pleural vent over an average of 3 days. Two patients were managed with an ambulatory bag over an average of 22 days.
We previously reported that five patients who had been referred for local anaesthetic medical thoracoscopy (LAT) and symptoms pertaining to fluid were being palliated by indwelling pleural catheters (IPC).5 Given cancellation of elective theatre work, day-case LAT was not an option for us. See supplementary material S1, Table S1, for a summary of patients with malignant effusions and their outcomes.
Six indwelling peritoneal catheters for patients with malignancy related ascites were inserted. The mean age was 59.7 years and mean number of preceding paracenteses was 0.67. All were done as day cases. The diagnoses were breast, gastric, pancreatic, bowel and unknown primary cancers. It is worth noting that one of the patients was SARS-CoV-2 positive at the time of the procedure.
We are past the peak of the pandemic and currently looking at ways to restart previous services. It has proved to be a challenging time with the surgical constraints in the COVID-19 era.6 The future is uncertain as a second peak is currently developing in some parts of the world. For the processes that were instigated above, we are better prepared in the event of one.
Supplementary material
Additional supplementary material may be found in the online version of this article at www.rcpjournals.org/fhj:
S1 – Summary of patients with malignant effusions and their outcomes.
Acknowledgements
The authors thank Drs David Cooper, Claire Mcbrearty and Katie Frew, and Miss Sarah Robinson for their ongoing help in the local service.
- © Royal College of Physicians 2020. All rights reserved.
References
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- Aujayeb A
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- Jones L
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- Armstrong L
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- Aujayeb A
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- Aujayeb A.
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- Royal College of Surgeons of England
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