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Consensus Guideline

Pleural Drains in Adults

Unblocking a pleural catheter

Indications

  • A blocked pleural catheter in patient with pleural effusion or empyema ONLY.
  • Flushing of pleural catheter for any other conditions is CONTRAINDICATED.
  • Medical request for unblocking of pleural catheter must be documented in the clinical notes and medication chart prior to attempting the unblocking procedure.

Procedure

Two RNs must be in attendance, with at least one trained and competent in the procedure. See Appendix 6 Guidance for assessing competency in pleural procedures for advanced trainees and specialist nurses.

Don PPE - non sterile gloves, gown, apron and facial protection.

Unblocking large bore intercostal catheter

Equipment

  • Howard Kelly clamps
  • 3x sterile catheter tip syringes each with 30mls sodium chloride for irrigation
  • Large dressing pack

Procedure

  1. Clamp ICC near patient and above connections.
  2. Disconnect UWSD tubing.
  3. Unclamp and slowly aspirate tube, then instil sodium chloride.
  4. Gently aspirate sodium chloride from ICC.
  5. Clamp the tube and remove syringe.
  6. Reconnect to UWSD.
  7. Remove clamps and check patency.
  8. Repeat process with another catheter tip syringe + 30mls sodium chloride if indicated.
  9. Document the procedure and outcome in clinical notes.
  10. The UWSD should oscillate post procedure - if not notify MO.

Unblocking small bore intercostal catheter

Equipment

  • Three way tap port
  • 3x sterile 50ml luer lock syringes each with 10mls sodium chloride for irrigation
  • Large dressing pack

Procedure

  1. Turn three way tap off to the patient
  2. Ensure smart site bung is attached to three way tap port
  3. Connect a 50ml luer lock syringe either
    • directly into disinfected bung
    • disconnect bung and connect
  4. Turn three way tap to neutral position
  5. Gently aspirate PPC and then instil sodium chloride
  6. Gently aspirate sodium chloride from PPC
  7. Turn three way tap off to patient and on to the drain, push fluid into drain
  8. Turn three way tap off to patient and disconnect syringe
  9. Reconnect bung if required and turn tap to neutral position
  10. Repeat the process with another syringe and sodium chloride if required
  11. Document procedure and outcome in clinical notes and document additional (up to 30mls) on UWSD chart
  12. The UWSD should oscillate post procedure - if not notify MO

Bottle changes

  • Performed by two RNs who have been instructed in the procedure. See Appendix 6 Guidance for assessing competency in pleural procedures for advanced trainees and specialist nurses.
  • The frequency of drainage system changes is guided by manufacturer's instructions and their specified volumes.
  • Prepare the new system and ensure water seal is set as per manufacturer's instructions.
  • Perform hand hygiene.
  • Full PPE - Don gloves, apron, facial protection and non-sterile gloves.
  • Clean connections with antiseptic solution.
  • If no air leak - clamp ICC above the connection for approximately one breath as UWSD bottle / chamber is changed.
  • If there is an air leak (indicated by bubbling in the UWSD) do not clamp the catheter but ask the patient to hold their breath while changing the drainage system.
  • Ensure all connections are secure before unclamping the ICC.
  • Change bottle/chamber.
  • Perform hand hygiene.
  • Document UWSD system change in patient's medical record.

Disposal of drainage

All UWSD bottles /chambers are disposable.

Do not empty the UWSD contents - seal the UWSD unit prior to disposal in a yellow contaminated waste bin.