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July 2020

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Dr Sanjeevan Muruganandan, patient Noel Smith, Kirstin Tirant and Dr David Feng

Stay-at-home service for northern pleural patients

Northern Health’s respiratory department has launched a specialist ambulatory service as part of its pleural medicine unit – the only formalised service of its kind in Victoria.

Pleural diseases occur when there is a problem in the chest cavity, the space between the lung and the chest wall.

This often results in the production of fluid in the chest cavity – pleural effusion – which can lead to breathlessness, chest pain and other symptoms.

Fluid in the chest cavity may become infected – empyema/pleural infection – and air from the lung may sometimes escape into the chest cavity – pneumothorax.

Pleural diseases are common and the burden is increasing.

The pleural medicine unit aims to optimise care in patients with pleural diseases by reducing procedures, hospitalisation and standardising care pathways.

‘There are more than 50 recognised causes of pleural effusion and our approach is to provide a service that accurately and quickly diagnose the cause of the pleural problem so that the appropriate treatment can be given,’ said lung specialist and pleural lead Sanjeevan Muruganandan.

‘The aim of this innovative service is to reduce further procedures and pleural-related hospitalisation, work collaboratively with our thoracic surgical colleagues and ultimately standardise care in all aspects of pleural diseases.

‘In some patients who aren’t fit for surgery, the service offers a less invasive option, which is evidence-based,’ Dr Muruganandan said.

For example, an indwelling pleural catheter (IPC) can be inserted by the team to assist in the management of chronic recurrent pleural effusion, allowing patients to drain away the fluid whenever they have symptoms, such as shortness of breath.

This prevents them from having multiple procedures, prolonged and further hospitalisation.

Noel Smith was a patient who had an IPC inserted.

‘It meant a lot to me because I was able to be awake while they were doing it and it wasn’t painful.

‘They explained to me what they were doing and it gives you hope if you know what’s going on – especially when you’re awake – I just thought that was tremendous,’ Mr Smith said.

‘My quality of life definitely improved once I had the catheter in – it helped to take the fluid off, so I was breathing much better.

‘Confidence-wise, too, I thought the way they treated me and explained things to me – it built my confidence up so much.’

The service is unique with the first pleural clinical nurse consultant in Victoria – Kirstin Tirant.

Ms Tirant acts as a direct contact for patients, as well as nursing staff, when they need assistance, helping them over the phone and reducing the need for patients to have to present to hospital.

With the addition of Dr David Feng earlier this year as the pleural fellow, the service is growing rapidly and contributing to research in this field.

‘For patients with cancer, it’s often more about treating the pleural effusion,’ Dr Muruganandan said.

‘Some patients have a very short life-span, so we try to improve their symptoms and quality-of-life by helping them stay at home for as long as they can by offering that support system,’.

The team is able to fast-track patients to the pleural clinic, avoiding presenting to the emergency department.

‘We have a consult service for the hospital which helps expedite their management plan,’ Ms Tirant said.

‘Our team is often involved at the beginning, helping to provide a diagnosis and we support them throughout their journey.

‘As a team being present throughout their whole journey, we can link these patients with the correct service at the right time.’