Introduction
The Pleural Drains in Adults - Consensus Guideline has been developed with the aim to improve the care provided to adult patients with a pleural drain in NSW acute hospital facilities. The recommendations contained within this document may also be suitable for older adolescents requiring pleural drain insertion. The need for this consensus guideline has arisen from concerns raised by respiratory clinicians related to instances of suboptimal and unsafe clinical management of adult patients with pleural drains within NSW acute facilities. The clinician concerns were substantiated through a Clinical Excellence Commission review of 185 pleural drain related incidents reported in NSW (2010/11) which showed that two thirds were attributed to suboptimal clinical management.
The Agency for Clinical Innovation (ACI) Respiratory Network convened a Pleural Procedures group comprising respiratory physicians and respiratory clinical nurse specialists in 2012. The ACI Pleural Procedures Group identified the need for appropriate and safe care of patients with a pleural drain to be detailed in a consensus guideline. The guideline describes aspects of clinical care, clinician skills and processes within a facility that if followed will reduce the risks associated with the insertion of pleural drains (non-emergency), ongoing management, trouble shooting and removal of pleural drains in adult patients.
The British Thoracic Society Pleural Disease Guidelines 20101-8 are widely accepted by respiratory clinicians as the key evidence based guidelines for the investigation and management of pleural disease including specific pleural drain procedures in adults. The ACI Pleural Drains in Adults - Consensus Guideline describes aspects of care that fall outside the Pleural Disease Guidelines.
The recommendations for clinical care outlined in this consensus document are available to be incorporated into local clinical resources with the aim to support health care professionals and facility managers within NSW Local Health Districts to provide safe and effective care of adults with a pleural drain.
Exclusion
Indwelling Pleural Catheters or Tunnelled Catheters are specialised procedures which are performed in dedicated units and as such are considered outside the scope of this document.