Nurse-led management of pleural effusions, in patients with a lung cancer or mesothelioma
The problem identified
Patients frequently presented as an emergency and their pleural effusion management was often inappropriate. Symptoms patients presented with were breathlessness, anxiety, cough and pain. Patients were often frightened and aware cancer may be spreading. Lack of support for patients was apparent, lung CNS often not informed of events. The intention was to introduce a robust patient centred service.
The intervention made to change the problem
Post a diagnosis of pleural effusion patients, GPs and community palliative care team (CPCT) are encouraged to contact the Macmillan lung CNS if new or persisting symptoms. Prompt clinic review is arranged. If pleural effusion is suspected, the patient is reviewed by a respiratory advanced nurse practitioner (ANP) and during the same visit has an ultrasound scan and therapeutic aspiration.
All patients are given an information leaflet and the ANP contact details. The patient is assessed by theANP and discussed with a respiratory consultant regarding suitability for thoracoscopy, pleurodesis, and insertion of indwelling pleural catheter or symptomatic drainage. All decisions are made on an individual basis taking into account a patient's diagnosis, performance status, co morbidities, type of effusion and patient preference. MDT members are informed of any intervention performed.
Patients return to the ward on day 7 and are seen by the ANP, and the stitches removed. The district nurse attends this visit to meet patients and arrange future drainage.
How it changed my practice
Symptomatic pleural drainage by an ANP in the pleural room on the respiratory ward; frequency flexible to meet the needs of the patient. The accessibility of this service has been warmly welcomed by patients and carers. Patients tell us they feel supported. It minimises hospital admissions and outpatient clinic appointments, thus reducing travel and hospital transportation costs. This resource is an example of how a service can be adapted to meet the needs of the patient and provides evidence of seamless working through primary and secondary care. Reducing emergency hospital admissions for the management of pleural effusions in patients with a lung cancer or mesothelioma.
The patient is informed of suspicion of cancer, further investigations arranged and information given. The patient is seen by the lung CNS and given date to return for results.
Resource / Cost implications
Advanced nurse practitioner with appropriate training and an interest in the management of pleural infusions. Conversion of the pleural room on the respiratory ward with ward based ultrasound machine. Running an educational teaching session for primary and secondary care.