Medical Officer (MO) Training
All doctors expected to be able to insert a pleural drain should be trained using a combination of:
- an initial theoretical component describing the risks and techniques
- simulated practice
- directly observed supervised practice until considered competent*
- the trainee should ensure each insertion procedure is documented in their log book and signed by the experienced trainer (Pleural Procedures Training Form (pdf 18KB))
- the procedures of inserting a Small Bore Intercostal Catheter by Seldinger technique and Large Bore Intercostal Catheter by blunt dissection should be performed by operators who have competency in the specific insertion procedure and its indications, risks and complications. See Appendix 6 Guidance for assessing competency in pleural procedures for advanced trainees and specialist nurses
- in the anticipated absence of fluid or air at the time of insertion (e.g. prophylactic drains) the intercostal drain should only be inserted by operators who have been deemed competent in the specific procedure and its indications, risks and complications.
*The MO performing the procedure will have been deemed competent through having performed supervised insertions of pleural drains (large bore and/or small bore intercostal catheters) based on operative credentialing systems in place at their respective facility.
MO will have previously witnessed one such insertion AND has present a MO credentialed in large bore and/or small bore intercostal catheter (ICC) insertion (as applicable) directly supervising the procedure throughout.
Pleural Drain Endorsed Nurse
A facility endorsed pleural drain nurse (one with prior experience assisting in the insertion of intercostal catheters and the management of pleural drains and under water seal drainage system (UWSD)) is present throughout the procedure. See Appendix 6 Guidance for assessing competency in pleural procedures for advanced trainees and specialist nurses.
A procedure safety checklist level 2 is undertaken by MO operator and nurse.
- Check correct patient.
- Check the correct site both clinically and radiologically.
- Check anti-coagulation status.
The nurse's role is to:
- ensure resuscitation trolley available
- ensure the required equipment is present
- monitor patient's vital signs and observe for evidence of patient deterioration throughout the procedure
- in the event of patient deterioration follow Between the Flags escalation process assist and maintain optimal patient position
- ensure a sterile field is maintained throughout the procedure
- observe the proceduralist to ensure no deviation from correct insertion procedure
- provide patient advocacy
- 'Call Stop' if unwarranted risks are observed before or during the procedure and escalate for assistance