A Policy for the Management of Indwelling Pleural Catheter
V6.0
September 2015
Summary.
Drainage Procedure – all of the equipment should be found in the dressing pack.
6.1.1. Ensure the patient is comfortable and fully informed about the procedure.
6.1.2. Wash hands.
6.1.3. Open dressing pack and drainage bottle.
6.1.4. Wearing disposable gloves, remove the dressing.
6.1.5. Wash hands
6.1.6. Put on sterile gloves
6.1.7. Clamp drainage bottle.
6.1.8. Remove cover from access tip on drainage bottle.
6.1.9. Remove catheter cap from catheter.
6.1.10. Using sterile alcohol swabs, wipe the end of the catheter.
6.1.11. Insert access tip into catheter until you hear and feel a click.
6.1.12. Release both clamps.
6.1.13. Drain slowly. It is recommended that you limit a single drainage to no more than
1000mls.
6.1.14. Drain fluid until it stops draining. If patient experiences pain, excessive coughing or
becomes breathless, stop draining. Administer analgesia if required.
6.1.15. Clamp bottle.
6.1.16. Remove drainage line from catheter.
6.1.17. Place sterile cap on the end of the catheter (a new cap each time).
6.1.18. Position the pad around the catheter.
6.1.19. Wind the catheter around the pad.
6.1.20. Cover with gauze
6.1.21. Secure with vapour-permeable adhesive film. Do not apply film directly to the
catheter.
6.1.22. Dispose of all equipment in the appropriate bag for clinical waste. (For community
patients – arrange for local county council to collect for incineration. Do not cut off the
green indicator and empty).
Table of Contents
1. Introduction...... … 3
2. Purpose of this Policy ...... 3
3. Scope ...... 3
4. Definitions / Glossary...... … 3
5. Ownership and Responsibilities...... 3
6. Standards and Practice ...... 4
7. Dissemination and Implementation...... 5
8. Monitoring compliance and effectiveness...... 5
9. Updating and Review...... 6
10. Equality and Diversity...... 6
Appendix 1. Governance Information ...... 7
Appendix 2.Initial Equality Impact Assessment Screening Form...... 9
1. Introduction
1.1. The indwelling pleural catheter is used for the drainage of a pleural effusion. The catheter is inserted into the pleural space of patients who have recurrent pleural effusions or where pleurodesis is not possible.
2. Purpose of this Policy/Procedure
2.1. To provide all staff treating patients who have an indwelling pleural catheter insitu with the appropriate information, education and training to ensure there is an understanding of the management of the catheter to –
• Relieve breathlessness
• Stop readmission to hospital for repeated pleural aspirations
• Improve quality of life
• Delivering a cost saving
3. Scope
3.1. This strategy applies to all those involved in service redesign, from Executive level, through to Divisional Management teams to staff members working directly in clinical services who are involved in looking at their own service redesign.
3.2. The RCHT lead for overseeing the management of the indwelling pleural drain will be supported by the Divisional Management Team
4. Definitions / Glossary
5. Ownership and Responsibilities
All members of staff involved in the drainage of pleural fluid using and indwelling pleural catheter.
5.1. Role of the Managers
Line managers are responsible for ensuring their staff have had the correct training to carry out the procedure.
5.2. Role of Individual Staff
5.21. All staff members are responsible for ensuring they have read the document and adhere to the information given.
5.22. Staff should ensure the equipment is sterile and in date.
5.23.All staff should be aware of personal limitations. They should declare to a senior member of staff it they do not feel they are competent to carry out the procedure.
5.24. A standardized approach will be used by all nurses for individual patients. If any further training is required then the nurse should seek advice from a senior member of the team.
6. Standards and Practice
6.1 Drainage Procedure – all of the equipment should be found in the dressing pack.
6.1.1. Ensure the patient is comfortable and fully informed about the procedure.
6.1.2. Wash hands.
6.1.3. Open dressing pack and drainage bottle.
6.1.4. Wearing disposable gloves, remove the dressing.
6.1.5. Wash hands
6.1.6. Put on sterile gloves
6.1.7. Clamp drainage bottle.
6.1.8. Remove cover from access tip on drainage bottle.
6.1.9. Remove catheter cap from catheter.
6.1.10. Using sterile alcohol swabs, wipe the end of the catheter.
6.1.11. Insert access tip into catheter until you hear and feel a click.
6.1.12. Release both clamps.
6.1.13. Drain slowly. It is recommended that you limit a single drainage to no more than
1000mls.
6.1.14. Drain fluid until it stops draining. If patient experiences pain, excessive coughing or
becomes breathless, stop draining. Administer analgesia if required.
6.1.15. Clamp bottle.
6.1.16. Remove drainage line from catheter.
6.1.17. Place sterile cap on the end of the catheter (a new cap each time).
6.1.18. Position the pad around the catheter.
6.1.19. Wind the catheter around the pad.
6.1.20. Cover with gauze
6.1.21. Secure with vapour-permeable adhesive film. Do not apply film directly to the
catheter.
6.1.22. Dispose of all equipment in the appropriate bag for clinical waste. (For community
patients – arrange for local county council to collect for incineration. Do not cut off the
green indicator and empty).
6.1 Further Recommendations
6.2.1. Indwelling pleural catheters are inserted to drain pleural fluid and relieve breathlessness, stop re-admission into hospital for repeated pleural aspirations and improve quality of life.
6.2.2. Sutures are to be removed from incision site after 7 days post line insertion.
The sutures around the line itself should be removed 3 weeks post line insertion
6.2.3. Change in colour of pleural fluid: if the pleural fluid were to become cloudy then take a sample of fluid.
6.2.4. Redness: If redness develops around the line then swab the area, check vital signs.
6.2.5. If redness increases or patient feels unwell, contact GP, Wellington Ward or Lung Cancer CNS’s on 01872 252015
6.2.6. Drainage: Catheter to be drained 3 times weekly (for the first 3 weeks). Record fluid drained on the monitoring sheet.
6.2.7. Generally : patients have their pleural catheter drained 3 times a week for the first 3 weeks, then twice weekly for a couple of weeks. If pleural fluid continues to diminish, drainage becomes weekly – fortnightly. If no fluid has been drained on 2 – 3 occasions, contact lung cancer CNS’s for advice about co-ordinating removal. Patients will need a CXR to confirm pleurodesis and a date will then be given for removal.
6.2.8. If you need advice before changing the drainage regime contact the Lung Cancer Nurses on 01872 252015 for further instructions.
Useful contact numbers-
Lung cancer CNS Sue Pascoe / Paul Kneller 01872 252015
Wellington Ward (Respiratory) 01872 252100
Crown Hill Ward (Derriford) 0845 1558274
7. Dissemination and Implementation
7.1. This document will be added to the Trust electronic Documents Library.
7.2. All staff who are involved in the care of patients requiring drainage pleural fluid using an indwelling pleural catheter will be informed of the new policy.
8. Monitoring compliance and effectiveness
Element to be monitored / All staff who are involved in the care of patients requiring drainage pleural fluid using an indwelling pleural catheterLead / Unit / Line Managers
Tool / Staff training records
Frequency / As required
Reporting arrangements / Any incidents regarding the use of the indwelling pleural catheter will be reported on DATIX
Acting on recommendations and Lead(s) / Recommendations made will be implemented by the various staff groups – Lung Cancer Clinical Nurse Specialists, Ward Manager Wellington Ward.
Change in practice and lessons to be shared / Required changes will be identified and actioned within 4 weeks or as agreed in the action plan. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders.
9. Updating and Review
9.1. This policy will be reviewed no less than 3 years after issue unless changes in equipment provision require an earlier review.
10. Equality and Diversity
10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement.
10.2. Equality Impact Assessment
10.21 The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Appendix 1. Governance Information
Document Title / Guidelines on the management of the indwelling pleural catheterDate Issued/Approved: / 1 September 2015
Date Valid From: / 1st September 2015
Date Valid To: / 31st August 2018
Directorate / Department responsible (author/owner): / Sue Pascoe, Lung Cancer Clinical Nurse Specialist
Contact details: / 01872 252015 or bleep 3061
Brief summary of contents / To provide guidance for all staff treating patients who have an indwelling pleural catheter
Suggested Keywords: / Pleural drain, effusion
Target Audience / RCHT / PCH / CFT / KCCG
ü
Executive Director responsible for Policy: / Medical Director
Date revised: / 1st September 2015
This document replaces (exact title of previous version): / A Policy for the management of Indwelling pleural catheter
Approval route (names of committees)/consultation: / Respiratory Consultants
Divisional Manager confirming approval processes / Head of relevant Division
Signed copy on file
Name and Post Title of additional signatories / Not required
Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings / Dr John Myers
Name:
Signature of Executive Director giving approval / {Original Copy Signed}
Publication Location (refer to Policy on Policies – Approvals and Ratification): / Internet & Intranet / ü / Intranet Only
Document Library Folder/Sub Folder / Respiratory
Links to key external standards / Governance Team can advise
Related Documents: / Reference and Associated documents
Training Need Identified? / Yes, this can be carried out by competent ward staff
Version Control Table
Date / Version No / Summary of Changes / Changes Made by(Name and Job Title)
10 Jun 10 / V1.0 / Initial Issue / Andrew Rogers
Corporate Records Manager
29 Oct 10 / V2.0 / Amendment of Governance coversheet to include ‘Suggested Keywords’, ‘Training Need’ and ‘Publication Location’. / Andrew Rogers
Corporate Records Manager
1 Feb 11 / V3.0 / Addition of Monitoring Compliance table. / Andrew Rogers
Corporate Records Manager
15 Jan 12 / V4.0 / Governance information moved to an appendix. EIA updated. / Andrew Rogers
Corporate Records Manager
25 Jan 12 / V4.1 / Governance information amended to align with format of Document Manager Upload Form. / Andrew Rogers
Corporate Records Manager
20 Sep 12 / V5.0 / Amended and updated / Sue Pascoe Lung Cancer CNS
1 Sep 15 / V6.0 / Amended and updated / Sue Pascoe Lung Cancer CNS
All or part of this document can be released under the Freedom of Information Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager.
Management of Indwelling Pleural Catheter
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Appendix 2. Initial Equality Impact Assessment Form
Name of Name of the strategy / policy /proposal / service function to be assessed:Guidelines on the management of the indwelling pleural catheter
Directorate and service area:
Medicine / Is this a new or existing Policy?
Existing
Name of individual completing assessment: Sue Pascoe / Telephone:
01872 252015 or bleep 3061
1. Policy Aim*
Who is the strategy / policy / proposal / service function aimed at? / To provide guidance on the management of indwelling pleural catheters.
2. Policy Objectives* / To provide guidance on the management of indwelling pleural catheters.
3. Policy – intended Outcomes* / To provide guidance on the management of indwelling pleural catheters.
4. *How will you measure the outcome? / Correct use of the indwelling catheter.
Relief of breathless and avoid or reduce hospital stay.
5. Who is intended to benefit from the policy? / Patients with a a recurring pleural effusion..
6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy?
b) If yes, have these *groups been consulted?
C). Please list any groups who have been consulted about this procedure. / Yes
Yes
Nursing staff in Respiratory and Oncology
7. The Impact
Please complete the following table.
Are there concerns that the policy could have differential impact on:
Equality Strands: / Yes / No / Rationale for Assessment / Existing Evidence
Age / √
Sex (male, female, trans-gender / gender reassignment) / √
Race / Ethnic communities /groups / √
Disability -
Learning disability, physical disability, sensory impairment and mental health problems / √
Religion /
other beliefs / √
Marriage and civil partnership / √
Pregnancy and maternity / √
Sexual Orientation,
Bisexual, Gay, heterosexual, Lesbian / √
You will need to continue to a full Equality Impact Assessment if the following have been highlighted:
· You have ticked “Yes” in any column above and
· No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or
· Major service redesign or development
8. Please indicate if a full equality analysis is recommended. / Yes / No√
9. If you are not recommending a Full Impact assessment please explain why.
Signature of policy developer / lead manager / director / Date of completion and submission
Names and signatures of members carrying out the Screening Assessment / 1.
2.
Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD
A summary of the results will be published on the Trust’s web site.
Signed ______Sue Pascoe______
Date ______17/07/2015_____
Management of Indwelling Pleural Catheter
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