Pleurx Pleural Catheter

Pleurx Pleural Catheter Policy 

Purpose: To outline the care and management of residents requiring pleural catheter drainage for a malignant pleural effusion, ensuring adherence to CMS guidelines and the State Operations Manual for long-term care facilities. 

Standard Precautions Required: 

• Explanation to Patient Required 

• Document all policy effectiveness to patient outcomes 

Skill: 

• RN/LPN Trained in Pleurx Catheter Care 

MD Order Required: Yes 

Equipment: 

• Pleurx Drainage System with Bottle 

• Sterile Latex Gloves 

• Pleurx Drainage Kit 

Procedure: 

I. Care and Management: 

A. Draining the Effusion Post-Insertion: 

• Preparation: 

• Wash hands thoroughly. 

• Open the drainage procedure kit. 

• Open the pouch containing the vacuum bottle and place the end of the tubing inside the sterile wrapping paper. Place the bottle down on the table. 

• Examine the green vacuum indicator on the top of the bottle. It should be down. If it is up, do not use the bottle. Obtain a new bottle. 

• Put on one glove from the dressing change kit. 

• Procedure: 

• With the gloved hand, pick up the package of povidone swabs with the ungloved hand and open the packet with the gloved hand. 

• Cleanse the valve of the chest catheter with one povidone swab. Do not push the swab into the valve. 

• With the valve still in your gloved hand, pick up the drainage tube and insert its tip into the valve. Continue to push the tip into the valve until you hear a click. This indicates that the valve and the drainage tube are firmly connected. 

• Release the pinch clamp on the drainage tube. Fluid will immediately flow into the bottle. 

• Drainage will stop when there is no more fluid in the pleural space, or the bottle is full (500 ml). The flow may slow down after the bottle is half full. Do not drain more than 1000 mls of fluid from the chest. 

• Pinch the clamp on the tubing closed. 

• Remove the gloves and replace them with a second pair of clean gloves. 

• Grasp the drainage tube in your gloved hand and pull the tip out of the catheter valve. 

• Wipe the valve with one of the povidone swabs. 

• Place a new cap on the valve. 

• Clean the skin around the catheter with another swab. 

• Place the foam pad around the catheter and onto your chest. 

• Wind the catheter in loops and cover with gauze. 

• Secure the dressing with tape. 

• Dispose of the vacuum bottle(s) into a Hazardous Waste Container. 

II. Documentation: 

• Document symptoms, vital signs, and/or pulse oximeter readings pre and post-procedure. 

• Record pleural output source in the computer. 

• Document patient tolerance of the procedure and/or relief of symptoms with each drainage. 

• Update care plan as indicated. 

III. Education: 

• Document on the Multidisciplinary Education Record. 

• Ensure patient’s understanding of the reason for pleural drainage, the drainage procedure, and pain management techniques. 

• Instruct the patient to report any symptoms of distress, such as increased shortness of breath, tachycardia, dizziness, faintness, pain, etc. 

IV. Special Notes: 

• Some patients might feel pain during drainage, usually limited to the first few times they drain as the lung re-expands and the pleural surfaces touch. Instruct the patient to clamp the tubing partially or completely closed and wait a few minutes. Have them contact you if the pain does not cease or they have other problems associated with drainage. 

• Some patients may have more than 600 ml to drain at any one drainage procedure. It is important for them to drain all the fluid from their chest to achieve pleurodesis. Therefore, if fluid stops at around 500 ml or more, they should attach another bottle to ensure complete drainage. 

V. End of Procedure: 

• Remove the glove from your hand and replace it with the second glove. 

• Grasp the drainage tube in your gloved hand and pull the tip out of the catheter valve. 

• Wipe the valve with one of the swabs. 

• Place a new cap on the valve. 

• Clean the skin around the catheter with another swab. 

• Place the foam pad around the catheter and onto your chest. 

• Wind the catheter in loops and cover with gauze sponges. 

• Secure the dressing to your chest with the self-adhesive dressing. 

References: 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.