Flushing should only to be performed by clinicians that are experienced and accredited by the facility to undertake the procedure.

Indications

• To maintain tube patency in patient with pleural effusion or empyema ONLY.
• Flushing of pleural catheters for any other conditions is CONTRAINDICATED.
• Flush frequency and volume must be ordered on the medication chart by an MO and administered by an RN competent in the procedure normally 6/24.

Contraindications for flushing fine bore catheters

• An inexperienced operator should not flush a pleural catheter.
• Pneumothorax - pleural catheters and drainage bottles for pneumothorax should have a label affixed which is clearly marked 'Not to be flushed'.

Equipment for flushing

• Personal protective equipment (PPE) - non sterile gloves and facial protection.
• Flat bladed clamps for ICC, three way tap for pleural pigtail catheter (PPC).
• 1 x sterile 50ml luer lock syringe loaded with 10mls sodium chloride for irrigation.
• Chlorhexidine 2% & alcohol 70% swabs x 3.
• Large dressing pack.

Flushing procedure

• Turn three way tap off to the patient and TOWARDS the pleural drain.
• Perform hand hygiene.
• Ensure there is a needleless access device (smart site bung) attached to the three way tap port.
• Connect a 50ml luer lock syringe using either of the following two methods:
  1. disinfect the bung with the alcohol swabs and connect a 50ml luer lock syringe loaded with 10mls of sodium chloride
     or
  2. disconnect the bung, clean with alcohol swabs and connect a 50ml luer lock syringe loaded with 10mls sodium chloride.
• Turn the three way tap off to the UWSD (i.e. turned on to the patient).
• Gently aspirate and then instil the sodium chloride into the PPC i.e. towards the patient.
• Turn the three way tap off to the patient and disconnect syringe.
• Replace bung if required.
• Return tap to normal drainage position.
• Perform hand hygiene.
• Document the procedure and outcome in the clinical notes and document the additional 10mls of sodium chloride on the UWSD chart - ensure the entry is made across the line so that the flush is clearly documented.
• The UWSD should oscillate post flushing - if not inform the MO.