Policy Manual sample

MDT Home Health Care Agency, Inc. CLINICAL GUIDELINE FOR PLEURAL CARE PROCEDURES PURPOSE: The purpose of this Policy is to assist in pleural procedures ensuring a prompt diagnosis and facilitating safe and effective treatment. To provide all staff treating patients who have an indwelling pleural catheter insitu with the appropriate information, education and training to ensure an understanding of the management of the catheter to - • Relieve breathlessness • Stop readmission to hospital for repeated pleural aspirations • Improve quality of life • Delivering a cost saving Management of a unilateral pleural effusion All patients should have a full clinical assessment and history. Bilateral effusions are most commonly due to heart failure and aspiration should not be performed unless there are atypical features or they fail to respond to diuretic therapy. Recurrent malignant pleural effusions (MPE). The traditional standard of care for MPE is pleurodesis using chemical agents such as talc poudrage or slurry. The use on in-dwelling catheter is relatively safe and improves symptoms for patients with MPE. Placement of an in-dwelling pleural catheter may offer patients with limited quality of life and duration of survival shorter hospital stays and fewer major complications. In-dwelling pleural catheters are a well-established technology; however, their role in the broader context of a multi-disciplinary team dedicated to pleural services is an area undergoing development. For the treatment of MPE the aim of pleural services is to provide rapid symptomatic relief with a minimal number of invasive procedures, a focus on ambulatory care, and limited hospital stays. In-dwelling pleural catheters (IPCs) are soft, flexible catheters placed in the pleural space and tunnelled through the subcutaneous tissue. Attachment of a vacuum drainage bottle facilitates drainage and re- expansion of the lung and the catheter may remain in situ until death. Fluid may be drained as required, by patients, and in the home setting. The catheter may be removed if the patient experiences spontaneous pleurodesis. A disadvantage associated with the device is the duration of treatment; the catheter may remain in the patient’s body for extended periods of time, causing unease or exposing the patient to the risk of infection. For patients receiving an IPC, accessibility to appropriately trained staff from a number of specialties for follow-up and removal of the catheter (if necessary) should form a part of their management strategy. For patients presenting with trapped lung syndrome (where the lung cannot achieve full expansion) associated with MPE, tube thoracostomy and pleurodesis are not indicated and more invasive therapies are problematic as they require long recovery periods. An important consideration for the placement of an in-dwelling pleural catheter is whether a patient has ongoing access to trained staff in a day procedure setting. Insufficient follow-up may result in patients presenting to emergency departments and undergoing further interventions for complications or recurrence of symptoms, thereby increasing the costs associated with catheter placement. Some complications are associated with indwelling pleural catheters, such as infection or tumor invasion of the catheter track. Role of Individual Staff All staff members are responsible for ensuring they have read the document and adhere to the information given. Staff should ensure the equipment is sterile and in date. Be aware of personal limitations. Declare to a Director of Nursing (DON, Clinical Manager) it they do not feel they are competent to carry out the procedure. A standardized approach will be used by all nurses for individual patients. If any further training is required then the nurse should seek advice from the DON, Clinical Manager. Home Health Agency Nursing Care & Procedures K-207