Breathing space by Kate Hollins
When I was a student nurse back in the 1980s, caring for patients with malignant pleural effusion traditionally involved a lengthy hospital stay. I was quite frightened of chest drains, which were clumsy and cumbersome, with apparatus consisting of lengthy rubber tubing, and underwater drainage systems using heavy glass cylinders, like over-sized Kilner jars.
Rope-like sutures and large amounts of pink, sticky, sleek tape adhered to the patient’s chest wall, held the daunting structure in place. The risk of displacement of the drain apparatus required it to be kept upright and not pulled or tugged.
This left the patient dependent on others for assistance with mobility and the activities of daily living. I approached these patients with much anxiety, terrified that I would disturb their respiratory plumbing; goodness knows how they felt!
More breathing space
Three years ago, when I first encountered Dr. Guhan, chest physician, I had to challenge my thinking. He demonstrated that indwelling catheters are now neat, light-weight, soft silicone devices: a delicate tube is initially neatly sutured in place and protected by a showerproof dressing.
“Removing the fluid provides more breathing space”,
“The procedure is done using ultrasound and under local anaesthetic and the patient can be home by tea-time.”
In addition to the manufacturer’s product guidance, Dr. Guhan has produced a flowchart algorithm which provides district nursing staff with the autonomy to manage chest drains themselves, and a troubleshooting guide that indicates when to contact him for guidance. The flowchart indicates frequency of aspiration as determined by patient symptoms and pleural volume.
When required, disposable plastic bottles are attached to the catheter to allow pleural drainage. Anchoring sutures are removed seven days post-insertion. Thereafter, a polyester cuff forms a seal under the skin surface to hold the catheter in place.
Yes, it is. However, in order to enhance my own understanding and share this new knowledge with others, I was required to research a little more.
Back in control
In developing the workforce’s knowledge, one of my colleagues demonstrates the procedure in a YouTube video: Dr. Guhan has also provided educational sessions for district nurses, GPs and hospital personnel, with participation from patients who, despite the limited prognosis of malignant disease, have shared stories of the positive impact of being looked after within their community.
This patient-centred approach puts the individual back in control of their situation, allowing them to be cared for at home with minimal hospital attendance, usually on an out-patient basis.
This enables the patient to choose how to spend valuable time when feeling less fatigued: whether with family or friends, pottering about in the garage, at the flower show, or on the golf course. For those less able, breathlessness can be eased by draining their pleural catheter in the comfort of their own bed.
I am currently caring for a young lady with breast cancer, who developed a malignant pleural effusion 18 months ago. An indwelling pleural catheter really has provided her with breathing space: she is no longer breathless and can get on with life, getting married last autumn and now planning a family holiday to America.
Last week, I received an email from Dr. Guhan inviting me to a meeting to discuss the care of patients with heart failure who have chronic pleural effusions. He wants me to consider whether they can be managed at home with indwelling pleural catheters so they can have more breathing space too.
My learning continues…
This week’s blog was by Kate Hollins, Clinical Team Leader (District Nursing), South Ayrshire Health & Social Care Partnership, NHS Ayrshire & Arran