Pleural Procedures

Pleural procedures (especially intercostal drain insertion) performed in the investigation and management of pleural effusion and pneumothorax can cause significant harm and should only be performed by a competent practitioner.

• Has received theoretical education in thoracic anatomy, respiratory physiology, pleural disease and pleural techniques
• Has attended skills workshops, been trained in pleural procedures and undertaken simulated pleural procedures
• Has been appropriately supervised and subsequently signed off as competent (by a competent practitioner) in the performance of pleural procedures and has evidence (e.g., formative and summative DOPS) to prove this

In the case of procedures for pleural effusion a competent practitioner must also be trained in thoracic ultrasound to Royal College of Radiologists (RCR) Level 1(1) or Focused thoracic ultrasound standard (2)

• When these procedures are undertaken as part of training there must be appropriate education beforehand and close supervision of the trainee by a competent practitioner during the procedure
•  This protocol describes the process of managing a patient with suspected pleural effusion and /or pneumothorax both within and outside of normal working hours, and includes details of the technique to be used to insert a chest drain (appendix 1), as well the guidelines for the general management of pneumothorax and pleural effusion (appendices 2 and 3)
• Any patient in whom a chest drain has been inserted should be cared for on a ward with nursing staff trained in the care of chest drains and under the care (which may be joint) of a cardiothoracic surgeon, anaesthetist or chest physician
• There is a degree of risk associated with pleural procedures but with strict adherence to these guidelines it is hoped the risk should be minimised.
• ‘Outside of Office Hours’ (OOH) will differ depending on specialty and site but for the purpose of this policy refers to situations where the pleural procedure and post care management cannot be carried out within daytime staffing hours