CAREFUSION PLEURX CATHETER COMPETENCY

Glossary Pleural Effusion: Fluid in the thoracic cavity between the viscera and the parietal pleura Pleurodesis: Creation of adhesions between the parietal and visceral pleura to treat recurrent pneumothorax.

What Is It? The Pleurx Catheter is a flexible, tunneled catheter inserted to remove symptomatic, recurrent pleural effusion not responsive to medical management of the underlying disease. It is placed in the OR under local anesthesia and sedation.

Who is a Candidate? Malignant pleural effusions with dyspnea Chronic pleural effusions with dyspnea Pleural effusions requiring pleurodesis. Free from infection Free from coagulopathies

THE CATHETER This is a pliable catheter with fenestrations along the length which are inside the pleural space. There is a cuff at the skin level that is sutured in place The external tip has a one-way valve to prevent air from entering the chest cavity or fluid from draining out

THIS IS THE PLEURX CATHETER THIS SIDE IS OUTSIDE THE CHEST ONE WAY VALVE CAP THIS SIDE IS IN THE CHEST

Draining Fluid The external tip can be adapted for wall suction use or connected to an Atrium Chest Drainage system At GCH, we will use the vacuum bottle system to drain fluid The vacuum drain bottle kits are in SPD. There are extra valve caps and wall suction adapters in Distribution in case they are needed. This catheter is meant for intermittent drainage of fluid.

Patient Teaching There is a Patient teaching DVD on the GCH Patient Channel. The patient will receive a copy of this in the home care kit. Having the DVD on while you are draining the catheter is a good way to show the patient what they will be doing at home. Generally the catheter will be drained daily for the first week, then every other day after that. It can be drained in between if symptoms occur also. They can shower with the dressing on but no baths or swimming until Dr says so.

Patient Teaching In the Home Care kit there will be: 4 bottle draining kits, a DVD, and written information There will be an 800 phone number to call if they have questions There will be a wall chart outlining the drain process There will be an order form to send to the company for more kits The company will also be calling them to see if they need more kits sent

Symptoms of Pleural Effusion Sharp chest pain that is worse with cough or deep breathing Cough Fever Dyspnea Hyperventilation Decreasing O2 Sat Tachycardia

TO DRAIN FLUID When the patient is symptomatic the fluid should be drained to allow lung expansion and relief of symptoms. Do not drain more than 1,500 ml at one time The RN will be teaching the patient, family, or caregiver how to do this at home through demonstration, DVD instructions, and a written wall chart.

TO DRAIN FLUID To teach the patient, the instructions are on a 4 minute DVD located on the GCH TV Patient Channel The DVD and written wall chart are also in the take home kit There is an 1-800 phone number in the kit for the patient to call with any questions

Draining the Fluid To use the vacuum bottle system, organize all supplies first This is a clean procedure. Wash your hands first. Clean the table where you will be opening supplies.

THE STERILE PACKAGE In the Drainage Kit bag is a bottle and a sterile package The sterile package contains gloves, a new valve tip, alcohol wipes, a clamp, and dressings Open the blue sterile package close to the catheter on a table. Do not touch the inside of the sterile package until you have sterile gloves on. Bottle bottle Sterile package Dressing cover

Draining the Fluid Remove the old dressing from the catheter site using universal precautions and discard. Place the end of the catheter on the blue wrapper to keep it clean

Draining the Fluid Remove the vacuum bottle from its wrapper Close the clamp on the vacuum bottle Lay the end of the tubing on the edge of the blue wrapper keeping it clean.

Draining the Fluid Put on the gloves holding them by the cuff.

Draining the Fluid Open the package with the new valve cap letting it fall onto the blue wrapper.

Draining the Fluid Clean the end of the catheter with 1st alcohol wipe Connect the bottle drain tubing to the catheter You should hear and feel a click when it is secure.

Draining the Fluid Remove the guard over the top of the drain bottle and push the end of the tubing into the top of the bottle This creates a vacuum suction

Draining the Fluid at Home Slowly release the clamp, creating a vacuum. Fluid should drain into the bottle

Draining the Fluid If the patient cannot tolerate the removal of the fluid, decrease the vacuum pulling sensation by closing the clamp partially or completely, waiting a few minutes, then slowly opening it again. Let the patient know that they can self-adjust this at home.

Disconnecting the Catheter It should take 5-15 minutes to drain the fluid. When drainage is complete clamp the bottle tubing, disconnect the catheter, clean the tip with the 2nd alcohol wipe, and replace the cap with new sterile valve tip

Putting on the New Dressing Clean the skin around the catheter site with the 3rd alcohol wipe Place the split foam pad around the catheter Coil the catheter over the bandage and cover with other bandage

Draining the Fluid at Home Secure with clear adhesive dressing

Disconnect the tubing from the bottle by rotating the tip to create an opening and tilting it to the side to remove.

DISCARDING THE DRAINAGE AND BOTTLE At GCH discard the fluid in the hopper using universal precautions At home, with gloves on, empty the contents of the bottle into the toilet and flush At home, place the bottle in a zip-lock bag and seal. Throw away in trash. Remove gloves and wash hands