Purpose, aims and background
The recommendations define a standard for training and assessment of the knowledge and skills clinicians require in order to perform pleural procedures and provide ongoing pleural drain management. The primary targets are advanced trainees and respiratory nurses.
The recommendations relate to a range of pleural procedures including: needle thoracocentesis; closed pleural biopsy; insertion of small and large pleural catheters via Seldinger or blunt dissection technique; medical thoracoscopy; and indwelling (tunnelled) pleural catheters.
While it is recognised that other clinical specialties (including emergency care, critical care, interventional radiology, surgical specialties and paediatrics) may use specialty-specific credentialing processes, this set of recommendations is available for other clinical specialties to freely adopt or adapt for their own use.
The recommendations are intended for use in conjunction with the Pleural drains in adults: a consensus guideline.
The recommendations aim to:
- ensure pleural procedures are performed safely, effectively and without adverse events
- define a standard process for demonstrating that clinicians have undertaken the pleural procedural training and attained the clinical skills required across the range of pleural procedures
- help local health districts and special health networks adopt formal processes to ensure that relevant clinicians have undertaken appropriate pleural procedural training and demonstrated the clinical skills required to perform pleural procedures and care for patients following a pleural procedure
- enhance the pleural procedural experience for both patients and operators.
Some facilities, especially regional hospitals, may lack the full range of sub-specialty clinical services, including respiratory. In this instance, a facility may decide that the best means of achieving the recommendations is by creating a ‘pleural team’ or a ‘chest drain team’ whose members across a range of specialties have the appropriate experience and expertise in pleural procedures. A ‘pleural team’ may take on the role of auditing pleural procedures and monitoring patient outcomes within the facility.
In circumstances where appropriate expertise is not available within a hospital, formal telemedicine arrangements may be developed between a hub centre and its feeder peripheral hospital which would enable the hub centre to provide an on-call pleural procedure support service.
Accumulation of fluid or air within the pleural space is common and frequently requires drainage and/or other interventions. Significant and avoidable adverse events related to pleural drainage procedures have been identified via NSW Health clinical incident monitoring systems, of which the majority relate to suboptimal clinical management.
The ACI convened a Pleural Procedures Working Group (comprising clinical expert respiratory physicians and nurses) to lead the development of Pleural drains in adults: a consensus guideline. The guideline underwent extensive consultation prior to endorsement and release to the NSW Health system in May 2014.
To support statewide implementation of the guideline within NSW hospitals, the working group members identified the need to develop formal and consistent processes to determine competency for relevant advanced trainees and specialist nurses who are required to insert pleural drains and care for adult patients with a pleural drain.