BTS Guideline for Pleural Procedures and Thoracic Ultrasound

The BTS guideline on pleural procedures provides evidence-based recommendations for thoracentesis, chest tube insertion, and thoracic ultrasound in pleural disease.

Evidence-based guideline by BTS Pleural Disease Guideline Group.

Key recommendations: (1) Ultrasound guidance mandatory for all pleural procedures; (2) Primary spontaneous pneumothorax: aspiration first-line for large/symptomatic; (3) Secondary spontaneous pneumothorax: chest tube if large (≥2 cm) or symptomatic; (4) Tension pneumothorax: immediate needle decompression (2nd ICS MCL or 4th/5th ICS AAL); (5) Re-expansion pulmonary edema: limit drainage to 1.5 L per session.

Ultrasound is mandatory for all pleural procedures. Know the pneumothorax algorithm: primary (aspiration first) vs secondary (chest tube). Tension pneumothorax = immediate needle decompression, do not wait for imaging. Limit thoracentesis to 1.5 L to prevent re-expansion pulmonary edema.

Some recommendations based on observational data. Pneumothorax size measurement varies by method (BTS vs ACCP).