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Consensus Guideline

Pleural Drains in Adults

Recommendations for assessing competency in nurses

Patients with a pleural drain should be managed in a clinical environment where nurses deemed competent to manage chest/pleural drains are available at all times.

Each facility is responsible for accrediting designated nurses for pleural/chest drain management in line with their scope of practice. The competency recommendations aim to ensure that a consistent process is undertaken for nursing education, training and attaining competency in management of pleural drains within NSW.

Registered nurse/endorsed enrolled nurse pleural drain competency

Assessment of competency will entail specific consideration of all aspects required for the management of patients with a pleural drain and drainage devices.

Demonstrates an understanding of the fundamental principles of normal breathing and pleural drainage, including:

  • intrathoracic pressures
  • egulatory mechanisms
  • indications for insertion and removal of a pleural drain
  • principles of chest/pleural drainage systems.

Competently assesses patient and drainage system, including:

  • drainage type and amount
  • oscillation
  • air leak
  • patent tube and secure connections
  • dressing correct and intact
  • appropriate use of suction
  • need for bottle change.

Identifies cardinal signs of pleural drain complications and emergencies, including:

  • tension pneumothorax
  • surgical emphysema
  • blocked chest drain
  • dislodgement of chest drain
  • haemorrhage.

Demonstrates ability to set up equipment, prepare and appropriately manage a patient undergoing a pleural procedure, including:

  • understanding the role of an RN assisting the procedure
  • obtaining valid consent
  • maintaining Clinical Procedure Level 2 Safety Checklist Aseptic techniques and hand hygiene
  • pain assessment and ensuring adequate analgesia is ordered
  • educating patient and family
  • selecting appropriate equipment and assembling it correctly
  • recognising and managing complications
  • taking pre-, peri- and post-procedural observations
  • requirements for transfer and handover.

Displays knowledge of equipment required, current guidelines and procedure for:

  • clamping
  • flushing
  • correct dressing
  • changing bottles
  • performing observations according to risk and/or the patient’s condition
  • managing a dislodged pleural drain
  • unblocking a blocked drain
  • removing a pleural drain.

Maintains effective communication with patient, staff and others, including:

  • explaining procedures and interventions to patient and family
  • discussing and reporting adverse findings to the medical officer or senior nurses
  • appropriately documenting assessment findings on a chest drain chart and within progress notes
  • sharing information related to interventions and management of drainage system with colleagues at handover and when clinically relevant.