Transcript Introduction of a nurse-led clinic for patients discharged home with a

Introduction of a Nurse Led Clinic for
Patients Discharged Home with a Chest Drain
Jenny Mitchell, Advanced Nurse Practitioner – Thoracic Surgery
Cardiothoracic Surgery, John Radcliffe Hospital
A group of patients undergoing thoracic surgical procedures were identified as fit for discharge home apart from
continuing to require intercostal drainage. The Advanced Nurse practitioner for thoracic surgery has introduced a
nurse led clinic to provide follow up for these patients until the drains are removed, facilitating early discharge.
Intercostal Drains
Patient Pathway
Patient identified as suitable
for discharge home with a chest drain
•Epidural removed
•Pain controlled
•Bowels opened
•Mobilising
•Support at home
Drain needs to
remain insitu
Suction not
required
Admission for further
treatment
Ambulatory drain fitted
CXR satisfactory
Pain controlled
Patient education
Given contact details
Home
Advice from
telephone helpline
as required
Nurse led clinic:
•Respiratory assessment
•CXR
•Drain assessment
Drain not removed
Patient’s have either a Rocket Ambulatory
Chest Drain bag or a Atrium Express Mini
500 canister fitted prior to discharge. These
are both dry seal drains with a strap to
allows the patient to wear the drain across
their body. They can be inverted and are
safe for use outside of hospital.
Patient Education
Drain removed
Follow-up in
consultant led clinic
Conclusion
This new service aims to enhance the pathway of this group of thoracic
surgery patients by facilitating early discharge and improving patient
support and communication with the aim of improving patient satisfaction
The purpose and function of the drain is
discussed with the patient and their carers
prior to discharge. They are given written
information about the drain, how to care for
it and who to contact if they have concerns.
The GP and community nursing team are
contacted to provide wound care and
support to the patient and their carers.
References: Malik M and Black E (2009) Fast-track video-assisted bullectomy and pleurectomy for
pneumothorax: initial experience and description of technique. European Journal of Cardiothoracic
Surgery. 36 906-9. Reiger K, Wroblewski H, Brookes J, Hammond Z and Kesler K (2007) Postoperative
Outpatient Chest Tube Management: Initial Experience With a New Portable System. Annals of
Thoracic Surgery. 84 630-2.