CONSENSUS GUIDELINE
Pleural Drains in Adults
ACI Respiratory Network
Collaboration. Innovation. Better Healthcare.
, The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to
design and promote better healthcare for NSW. It does this by:
•
service redesign and evaluation – applying redesign methodology to assist healthcare providers and
consumers to review and improve the quality, effectiveness and efficiency of services
• s pecialist advice on healthcare innovation – advising on the development, evaluation and adoption of
healthcare innovations from optimal use through to disinvestment
• initiatives including guidelines and models of care – developing a range of evidence-based healthcare
improvement initiatives to benefit the NSW health system
• i mplementation support – working with ACI Networks, consumers and healthcare providers to assist
delivery of healthcare innovations into practice across metropolitan and rural NSW
• nowledge sharing – partnering with healthcare providers to support collaboration, learning capability and
k
knowledge sharing on healthcare innovation and improvement
•
continuous capability building – working with healthcare providers to build capability in redesign, project
management and change management through the Centre for Healthcare Redesign.
ACI Clinical Networks, Taskforces and Institutes provide a unique forum for people to collaborate across clinical
specialties and regional and service boundaries to develop successful healthcare innovations.
A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership with
healthcare providers to develop mechanisms to improve clinical practice and patient care.
www.aci.health.nsw.gov.au
AGENCY FOR CLINICAL INNOVATION
Level 4, Sage Building
67 Albert Avenue
Chatswood NSW 2067
PO Box 699 Chatswood NSW 2057
T +61 2 9464 4666 | F +61 2 9464 4728
E | www.aci.health.nsw.gov.au
SHPN: (ACI) 130351 ISBN: 978-1-74187-922-3
Produced by: ACI Respiratory Network
Further copies of this publication can be obtained from the
Agency for Clinical Innovation website at www.aci.health.nsw.gov.au
Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced
in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be
reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written
permission from the Agency for Clinical Innovation.
Cover image: Preparing a patient for insertion of the pleural drain in the triangle of safety
Version: V2.4
Date Amended: 2/11/2016
Published Apr 2014. Next Review 2023. © State of NSW (Agency for Clinical Innovation)
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 2
,Acknowledgements
The Agency for Clinical Innovation (ACI) recognises the unique position of Aboriginal people in the history and
culture of NSW. The ACI would like to acknowledge the traditional owners of the lands referred to in this report.
We would also like to acknowledge and pay respect to elders of the communities covered in this report.
Firstly we would like to express sincere thanks to the large number of people involved in consultations for this
project who gave willingly of their time, experience and stories so that this report can truly reflect consensus for
safe practice and support clinicians and acute facilities to implement improved care processes for management of
adults with a pleural drain.
Special thanks to the Clinical Expert reference group members for their continual support of the project.
The commitment and enthusiasm of current and past working and reference group members was integral
to each phase of the project. Members showed a willingness to share their knowledge and skills that was very
much appreciated.
ACI Pleural Procedures Respiratory Clinical Expert Reference Group:
• Cecily Barrack • Matthew Peters
• Belinda Cochrane • Paul Torzillo
• Mary Dunford • Scott Twadell
• David Foster • Adriaan Venter
• Ben Harris • Jonathon Williamson
• Baerin Houghton • Peter Wu
• Ben Kwan
Pleural Drains Specialist Nurses Reference Group:
• Mayrose Chan • Pat Lynch
• Cheryl Dickson • Cate McAlary
• Mary Dunford • Jocelyn McClean
• Kylie Furness • Catherine Reilly
• Ann Limpic • Patricia Reynolds
Thanks also to the Department Respiratory Medicine, Western Sydney Local Health District for permission to
include Pleural Procedures Training Form as an appendix.
The Agency for Clinical Innovation (ACI) is the lead agency in NSW for promoting innovation, engaging clinicians
and designing and implementing new models of care.
All ACI models of care are built on the needs of patients, and are underpinned by extensive research conducted in
collaboration with leading researchers, universities and research institutions.
For further details on the ACI visit: www.aci.health.nsw.gov.au
Cecily Barrack
Respiratory Network Manager
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 3
, Contents
Introduction 1
Be aware of the risks associated with pleural drains 2
Ten pleural drain risk reduction strategies 2
Pleural drain golden rules 3
Background 4
Section 1. Pre insertion of a pleural drain 5
Indications for pleural drains 5
Skilled operators 5
Thoracic ultrasound guidance 6
Pre-insertion risk assessment 6
Consent and pre medication 7
Confirm the site for drain insertion 8
Position the patient 8
Tube selection 9
Section 2. Insertion of a pleural drain 10
Equipment required for pleural drain insertion 10
Summary flowcharts 10
Seldinger technique 10
Insertion procedure 11
Blunt dissection 12
Pleural drain complications 14
Drainage systems 14
Immediate care post insertion of pleural drain 15
Secure the drain and connections 15
Section 3. Management and trouble shooting of pleural drains 16
Equipment required at bedside 16
Receiving a patient with an UWSD 16
Transferring a patient with an UWSD 17
Observations 17
Drainage 19
Flushing 23
Clamping 23
Unblocking a Pleural Catheter 24
Patient activity, hygiene and pain relief 27
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 4
Pleural Drains in Adults
ACI Respiratory Network
Collaboration. Innovation. Better Healthcare.
, The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to
design and promote better healthcare for NSW. It does this by:
•
service redesign and evaluation – applying redesign methodology to assist healthcare providers and
consumers to review and improve the quality, effectiveness and efficiency of services
• s pecialist advice on healthcare innovation – advising on the development, evaluation and adoption of
healthcare innovations from optimal use through to disinvestment
• initiatives including guidelines and models of care – developing a range of evidence-based healthcare
improvement initiatives to benefit the NSW health system
• i mplementation support – working with ACI Networks, consumers and healthcare providers to assist
delivery of healthcare innovations into practice across metropolitan and rural NSW
• nowledge sharing – partnering with healthcare providers to support collaboration, learning capability and
k
knowledge sharing on healthcare innovation and improvement
•
continuous capability building – working with healthcare providers to build capability in redesign, project
management and change management through the Centre for Healthcare Redesign.
ACI Clinical Networks, Taskforces and Institutes provide a unique forum for people to collaborate across clinical
specialties and regional and service boundaries to develop successful healthcare innovations.
A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership with
healthcare providers to develop mechanisms to improve clinical practice and patient care.
www.aci.health.nsw.gov.au
AGENCY FOR CLINICAL INNOVATION
Level 4, Sage Building
67 Albert Avenue
Chatswood NSW 2067
PO Box 699 Chatswood NSW 2057
T +61 2 9464 4666 | F +61 2 9464 4728
E | www.aci.health.nsw.gov.au
SHPN: (ACI) 130351 ISBN: 978-1-74187-922-3
Produced by: ACI Respiratory Network
Further copies of this publication can be obtained from the
Agency for Clinical Innovation website at www.aci.health.nsw.gov.au
Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced
in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be
reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written
permission from the Agency for Clinical Innovation.
Cover image: Preparing a patient for insertion of the pleural drain in the triangle of safety
Version: V2.4
Date Amended: 2/11/2016
Published Apr 2014. Next Review 2023. © State of NSW (Agency for Clinical Innovation)
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 2
,Acknowledgements
The Agency for Clinical Innovation (ACI) recognises the unique position of Aboriginal people in the history and
culture of NSW. The ACI would like to acknowledge the traditional owners of the lands referred to in this report.
We would also like to acknowledge and pay respect to elders of the communities covered in this report.
Firstly we would like to express sincere thanks to the large number of people involved in consultations for this
project who gave willingly of their time, experience and stories so that this report can truly reflect consensus for
safe practice and support clinicians and acute facilities to implement improved care processes for management of
adults with a pleural drain.
Special thanks to the Clinical Expert reference group members for their continual support of the project.
The commitment and enthusiasm of current and past working and reference group members was integral
to each phase of the project. Members showed a willingness to share their knowledge and skills that was very
much appreciated.
ACI Pleural Procedures Respiratory Clinical Expert Reference Group:
• Cecily Barrack • Matthew Peters
• Belinda Cochrane • Paul Torzillo
• Mary Dunford • Scott Twadell
• David Foster • Adriaan Venter
• Ben Harris • Jonathon Williamson
• Baerin Houghton • Peter Wu
• Ben Kwan
Pleural Drains Specialist Nurses Reference Group:
• Mayrose Chan • Pat Lynch
• Cheryl Dickson • Cate McAlary
• Mary Dunford • Jocelyn McClean
• Kylie Furness • Catherine Reilly
• Ann Limpic • Patricia Reynolds
Thanks also to the Department Respiratory Medicine, Western Sydney Local Health District for permission to
include Pleural Procedures Training Form as an appendix.
The Agency for Clinical Innovation (ACI) is the lead agency in NSW for promoting innovation, engaging clinicians
and designing and implementing new models of care.
All ACI models of care are built on the needs of patients, and are underpinned by extensive research conducted in
collaboration with leading researchers, universities and research institutions.
For further details on the ACI visit: www.aci.health.nsw.gov.au
Cecily Barrack
Respiratory Network Manager
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 3
, Contents
Introduction 1
Be aware of the risks associated with pleural drains 2
Ten pleural drain risk reduction strategies 2
Pleural drain golden rules 3
Background 4
Section 1. Pre insertion of a pleural drain 5
Indications for pleural drains 5
Skilled operators 5
Thoracic ultrasound guidance 6
Pre-insertion risk assessment 6
Consent and pre medication 7
Confirm the site for drain insertion 8
Position the patient 8
Tube selection 9
Section 2. Insertion of a pleural drain 10
Equipment required for pleural drain insertion 10
Summary flowcharts 10
Seldinger technique 10
Insertion procedure 11
Blunt dissection 12
Pleural drain complications 14
Drainage systems 14
Immediate care post insertion of pleural drain 15
Secure the drain and connections 15
Section 3. Management and trouble shooting of pleural drains 16
Equipment required at bedside 16
Receiving a patient with an UWSD 16
Transferring a patient with an UWSD 17
Observations 17
Drainage 19
Flushing 23
Clamping 23
Unblocking a Pleural Catheter 24
Patient activity, hygiene and pain relief 27
ACI Respiratory Network – Pleural Drains in Adults – A consensus guideline Page 4
