Flushing
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:
- disinfect the bung with the alcohol swabs and connect a 50ml luer lock syringe loaded with 10mls of sodium chloride
or - disconnect the bung, clean with alcohol swabs and connect a 50ml luer lock syringe loaded with 10mls sodium chloride.
- disinfect the bung with the alcohol swabs and connect a 50ml luer lock syringe loaded with 10mls of 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.