{"id":738,"date":"2015-11-09T17:43:32","date_gmt":"2015-11-09T17:43:32","guid":{"rendered":"http:\/\/hfhpulm.com\/info\/?p=738"},"modified":"2015-11-09T17:44:16","modified_gmt":"2015-11-09T17:44:16","slug":"workflow-thoracentesis-bronchoscopy-suite","status":"publish","type":"post","link":"https:\/\/hfhpulm.com\/info\/?p=738","title":{"rendered":"Workflow for thoracentesis in the Bronchoscopy Suite"},"content":{"rendered":"<p><strong>Inpatient<\/strong><\/p>\n<ul>\n<li>The GPU residents\/staff will order diagnostic\/therapeutic thoracentesis through EPIC. Arrangements have been made through EPIC, so that every time a thoracentesis order is typed, there will be 2 options: <strong>Thoracentesis-Pulmonary<\/strong> and Thoracentesis (radiology).<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Once <strong>Thoracentesis-Pulmonary<\/strong> is selected, the name of the patient will go to a workqueue in the bronchoscopy suite.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>If the order is entered <strong>before 2pm<\/strong>, thoracentesis should happen the same day. If it is after 2pm, the bronchoscopist will decide if it can happen the following day.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Once the thoracentesis is performed, the patient will return to his\/her room with recommendations given by the bronchoscopist.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>If further procedures are needed (diagnostic medical thoracoscopy, indwelling pleural catheters, chest tube), the Interventional Pulmonology (IP) Team should be consulted.<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<ul>\n<li>If patient needs surgical procedures, the IP Team will discuss it with Thoracic surgery.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Ideally, a patient with a recurrent pleural effusion of unknown etiology should undergo a diagnostic thoracoscopy after the second thoracentesis (at the latest), or after the first thoracentesis if one of the following criteria is met:<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Lymphocytic effusion (&gt;50% of lymphocytes)<\/li>\n<li>High pre-test probability of malignancy and negative cytology<\/li>\n<li>h\/o lung cancer (even if it is in remission)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>THORACENTESIS: GUIDELINES FOR THE PROCEDURE<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<ol>\n<li><strong>Inpatient Consult<\/strong><\/li>\n<\/ol>\n<ul>\n<li>Inpatient consult will be done by the Bronchoscopy Fellow or Bronchoscopy Staff.<\/li>\n<li>A note in Epic will be entered as part of the consult<\/li>\n<li>The fellow\/staff WILL communicate with the IPD consult team right after completing the thoracentesis, so that the IPD consult team will follow the patient\/results<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<ol start=\"2\">\n<li><strong>Workflow<\/strong><\/li>\n<\/ol>\n<ul>\n<li>Patient arrives to Bronchoscopy suite<\/li>\n<li>Evaluation by the nurse<\/li>\n<li>Evaluation by bronchoscopy fellow\/staff: includes consultation, physical exam, consent (in the same way as a Miniconsult)<\/li>\n<li>Patient MUST have a CXR imaging prior to thoracentesis (within the last 5-7 days at least)<\/li>\n<li>Thoracentesis to be performed in Bronchoscopy Room #3<\/li>\n<li>Nurse to evaluate the patient after the procedure<\/li>\n<li>Nurse to discharge patient<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<ol start=\"3\">\n<li><strong>Procedure: Guidelines<\/strong><\/li>\n<\/ol>\n<ul>\n<li>Every thoracentesis MUST be done under Ultrasound guidance<\/li>\n<li>The amount to be drained: will depend on the staff, but recommend to drain as much as possible<\/li>\n<li>Fluid analysis: the following tests are to be ordered on <strong>EVERY DIAGNOSTIC THORACENTESIS, AT LEAST<\/strong>:\n<ul>\n<li>LDH, Protein (pleural fluid and serum)<\/li>\n<li>Cell count and differential<\/li>\n<li>Cytology<\/li>\n<\/ul>\n<\/li>\n<li>Other tests in pleural fluid should be ordered depending on the case (depending on the staff)<\/li>\n<li>Therapeutic thoracentesis: no need to order analysis in fluid if there is already a diagnosis (will depend on the staff)<\/li>\n<li>A post-thoracentesis CXR has to be done in patients to assess for lung entrapment.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Inpatient The GPU residents\/staff will order diagnostic\/therapeutic thoracentesis through EPIC. Arrangements have been made through EPIC, so that every time a thoracentesis order is typed, there will be 2 options: Thoracentesis-Pulmonary and Thoracentesis (radiology). &nbsp; Once Thoracentesis-Pulmonary is selected, the name of the patient will go to a workqueue in the bronchoscopy suite. &nbsp; If [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[15],"tags":[],"class_list":["post-738","post","type-post","status-publish","format-standard","hentry","category-bronchoscopy"],"modified_by":"Jennings","_links":{"self":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/738","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=738"}],"version-history":[{"count":2,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/738\/revisions"}],"predecessor-version":[{"id":740,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/738\/revisions\/740"}],"wp:attachment":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=738"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=738"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=738"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}