This is an official Northern Trust policy and should not be edited in any way

Skin-tunnelled Indwelling (pleurx)

Catheters in Hospital and Community

Reference Number:

NHSCT/10/356

Target audience: This guidance is directed to hospital staff (including nurses, pharmacists and doctors) and Primary Care Staff (including GPs and Community Nursing).

Sources of advice in relation to this document: Mary Ann Conlon, Macmillan Lung Cancer Nurse Specialist

Replaces (if appropriate): N/A

Type of Document: Trust Wide

Approved by: Policy, Standards & Guidelines Committee

Date Approved: 16 September 2010

Date Issued by Policy Unit: 17 November 2010

NHSCT Mission Statement To provide for all the quality of services we would expect for our families

and ourselves

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Management of Skin-tunnelled Indwelling (pleurx)

Catheters in Hospital and Community

September 2010

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Guidance for Management of Patients with Skin-tunnelled Indwelling

(pleurx) Catheters in Hospital and Community

Introduction A. Management of pleural effusion: Recurrent pleural effusion is a therapeutic challenge for the physician and can be a source of continued morbidity for the patient. O’Hea et al (2004) claim that the use of intermittent pleural space drainage via an indwelling pleural catheter (commonly referred to as pleurx) is one solution, allowing for out patient drainage. In early studies looking at patients and families undergoing a structured teaching programme, long–term drainage catheters appeared to be well tolerated and associated with very few complications, providing an excellent option for palliative patients (Collinson et al 2004, O’Hea et al 2004, Gyniuk et al 2004). The cost of lung cancer in terms of human suffering and economic burden is considerable with a significant proportion of patients experiencing multiple and often complex physical problems including breathlessness (Krishnasamy and Wilkie 1999). Despite advances in the management of lung cancer in recent years, little impact has been made on survival rates for this disease and therefore quality time at home with families should be a priority. The use of indwelling chest catheters for the management of recurrent malignant pleural effusions offers a means of achieving this by providing an innovative method of managing effusions in the community, thereby relieving symptoms, giving the patient back some control and reducing the need for hospital admissions. Target audience This guidance is directed to hospital staff (including nurses, pharmacists and doctors) and Primary Care Staff (including GPs and Community Nursing). Aim of the guidance The aim of the guidance is to facilitate the transfer of patients across the secondary/primary interface. It further aims to ensure staff are well informed regarding the process of ordering equipment and the safe management of the patient both in hospital and at home. Equality, Human Rights and DDA This policy is purely clinical / technical in nature and will have no bearing in terms of its likely impact on equality of opportunity or good relations for people within the equality and good relations categories.

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Alternative Formats

This document can be made available on request on disc, larger font, Braille, audio-cassette and in other minority languages to meet the needs of those who are not fluent in English.

Sources of advice in relation to this document

The Policy Author as detailed on the policy title page should be contacted with regard to any queries on the content of this policy.

This guidance should be read alongside NHSCT policies on Infection Control and the Disposal of clinical waste. Policy Statement and Responsibilities Definition and practical considerations: A. Management of recurrent malignant pleural effusion:

The skin-tunnelled indwelling catheter is a tube (usually made of silicone), which is tunnelled under the skin into the pleural space. It has a self-sealing connector, which can be attached to a vacuum bottle and the fluid drained off. The patient, his/carer and District Nurse can be trained to carry out this procedure. The frequency of drainage will vary from patient to patient depending on the amount of pleural fluid produced and the surgeon will advise re this. At present, in N.Ireland, these drains are inserted in the Regional Thoracic Centre and patients are either discharged home or transferred to their local hospital. The following guidelines have been drafted to facilitate the transfer of such patients across the secondary/primary interface. In the event that the patient requires drainage while in hospital, ward staff are advised to refer to Instructions for Use Appendix 2. B. Management of malignant ascites: The skin-tunnelled indwelling catheters are now being used in Northern Ireland for the management of malignant recurrent ascites. Currently for managing ascites, the catheters are inserted in Belfast City Hospital through the Radiology department. Insertion is performed under local anaesthetic, usually as a day procedure.

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Ordering of equipment At time of writing any patient who normally resides in the NHSCT catchment area can have the drains (commonly referred to as pleurx) supplied via Mid-Ulster Hospital Community Pharmacy. It is very important that prior to discharge a supply of drainage kits is available. Community nurses who need to access supply of drainage kits should: 1. Complete NHSCT supplementary pharmacy requisition form 2. Identify the patient as “complex needs patient” under ward/department and include appropriate code ( see table below) Ordering Code Location

942 Complex needs patient Antrim/ Ballymena

943 Complex needs patient Mid-Ulster

944 Complex needs patient East Antrim

945 Complex needs patient Causeway

3. Include patients name, hospital number and DOB 4. Include address to which supply to be delivered.

Please Note: In ALL cases this address will be the Community Nurses office/store, or health centre (NOT the patient’s home address)

5. Name and address of Community Nurse who is co-ordinating the order. 6. Post or fax supplementary pharmacy requisition to:

Pharmacy Department Mid-Ulster Hospital

59 Hospital Road Magherafelt BT45 5EX Tel – 02879 366788 Fax – 02879 366755

7. Indwelling chest drain

At the time of writing, patients have the chest drains inserted by the thoracic surgeon in the Royal Victoria Hospital Day Procedure unit.

The Specialist Nurse Practitioner for Thoracic in the Royal Victoria Hospital is available as a resource and can arrange training for community nursing staff

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undertaking the management of patients with indwelling chest drains in community. The Specialist Nurse Practitioner for Thoracics is based in the Royal Victoria Hospital and can be contacted by: Mobile – 07917608613. Available Monday – Friday.

Ward 4A Nursing staff in the Royal Victoria Hospital may also be of help and can be contacted by direct line – 02890 633222.

8. Other useful contacts:

Macmillan Lung Cancer Nurse Specialist Fern House Antrim Area Hospital Site Tel – 02894 424716 Or through Antrim Area switch board – 028 9442 4000 Bleep – 5744 Available Monday - Friday

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� 1: PATIENT INFORMATION: On discharge after initial insertion of an

indwelling catheter, the patient should be provided with a drainage kit, a training

video/DVD and an information leaflet, which should include order codes etc.

Thereafter drainage kits should be supplied in packs of 10 to the patient at the

request of the District Nurse or GP.

� 2: Before issuing a drainage kit to patients, it must be verified by the issuer as

undamaged and within its expiry date.

� 3. For each patient issued with a supply, information must be completed on the

“Record of Issue Form” (Appendix 1).

� 4. The District Nurse responsible for the ongoing care of the patient with an

indwelling chest catheter must be contacted in adequate time prior to

discharge. A copy of the training video/DVD and Instructions for Use Manual

must be available on the ward for the District Nurse should this be required,

(Appendix 2).

� 5. In the case of a patient with lung cancer or mesothelioma, the District Nurse

should also be given the bleep number for the Lung Cancer Nurse Specialist,

and the discharging ward’s telephone number.

� 6. Drainage kits can currently be ordered on a Non-stock requisition form,

(Appendix 3 for order codes).

� 7. The “Record of Issue” form Appendix 1 must be filed in the patient’s notes,

one copy to the Lung Cancer CNS for audit purposes and a second copy to be

retained on the ward.

� 8. The GP should be sent a letter informing them that the patient is being

discharged with an indwelling catheter insitu, (Appendix 4).

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Appendix 1

Record of Issue of Indwelling Chest Drainage System

Ward: _____ Physician_______ Ward___ Physician ______________ Diagnosis__________ Pleurx catheter inserted by: _________________ Date of insertion______

Patient’s Name: Hospital No: Address: Tel No: DOB:

Training District Nurse trained? Yes/No Date______ Signature____________________ Carer trained? Yes/No Date______ Signature____________________ Video/CD supplied? Yes/No Date______ Signature____________________

Issue Number of bottles issued_____ Date issued______ Expiry date on bottles checked? Yes/No Bottles issued by: Signature _________________________________

Re-issue Only Number of bottles issued______ Date issued______ Expiry date on Bottles checked Yes/No Bottles issued by: Signature __________________________________

Community Details Health Centre: Address: Tel: GP: District Nurse: DN Tel:

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Appendix 2

*** Important note

When reading pleurx Denver biomedical Instructions For Use – appendix 2

1. In the NHSCT, alcohol pads are NOT to be used for skin cleansing. Please refer to

trust policy on skin cleansing around drain sites on PICC lines (e.g. Chlorhexidine

0.2%)

2. Although the “instructions for use” recommend thorough hand washing at the start of

the procedure, the NHSCT infection control department recommend thorough hand

washing at additional points in the procedure:

a. After removing the dressing

b. After dressing pack has been opened and prior to

putting on sterile gloves

c. If you need to change to a second drainage bottle

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Appendix 3 Information on supplier (please note supplies should be obtained through contacting Northern Trust Community

Pharmacy Department)

Denver Pleurx Catheter

Equipment ordering information Telephone Number: 0114 268 8880

UK Medical Ltd Albreda House Lydgate Lane

Sheffield S10 5FH

For procedures carried out by patients *prices current May 2010* This kit contains everything that is required

Pleurx Drainage kits Box of 10 Ref: HA-50-7510 £637.50 + £35 delivery charge + VAT

For procedures carried out by District Nurses These items can be bought separately to reduce costs. Dressings are supplied by District Nurse. E.g. Lyofoam, gauze, clear occlusive dressing, gloves, etc. These can usually be ordered on patient’s prescription.

Pleurx Vacuum Bottles Box of 10 Ref: HA-50-7210 £442.50 + £35 delivery charge + VAT

Pleurx Catheter Valve Cap Box of 10 Ref : HA-50-7235 £55 + £35 delivery charge + VAT

Orders placed before 2pm will normally be delivered in two to three days. Deliveries can be made to a hospital, health centre or in exceptional circumstances to the patient’s home.

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Appendix 4 GP Letter

Dr ………………………………… Address ………………………….. ………………………….. ………………………….. Date

Patient’s name: Address: Hospital No: DOB:

Dear Dr This is to inform you that the aforementioned patient has undergone insertion of an indwelling (pleurx) pleural/peritoneal catheter and has been discharged with this in situ. The catheter is an indwelling pleural catheter which is tunnelled under the skin into the pleural or peritoneal space. It has a self-sealing connector that can be attached to a vacuum bottle and fluid drained off. The use of these catheters for the management of recurrent malignant pleural effusions provides an innovative method of managing effusions in the community, facilitating the alleviation of symptoms and allowing patients to remain in their own homes for as long as possible at a time when quality of life is paramount. The patient and Community Nurses have been provided with training resources (i.e. Instruction manual and DVD). The patient has also been provided with a drainage kit. Further supplies can be obtained from UK Medical (see overleaf for details). If you would like more information on this equipment please do not hesitate to contact the staff listed below. Sincerely, Signature Designation

For advice/information Monday through Friday 9am – 5pm: Macmillan Nurses: Mary Ann Conlon Antrim Area Hospital Tel: 028 9442 4000 bleep 5744 Office: 028 9442 4716 Claire McFall Robinson Hospital Tel: 028 27660352 ext 4365 Causeway Hospital 028 7032 7032 bleep 1339 Long range bleep: 0769 961 3537 Out of hours advice: Ward A4 Antrim Area Hospital Tel: 028 9442 4997