The Introduction of Standardised Guidelines for
Talc Pleurodesis
The Cardiothoracic Unit
Claire Badger (ANP) and Mr J Asante-Siaw
Talc Pleurodesis
a) Direct visualisation
b) CT Scan
c) PET Scan
INTRODUCTION
●Procedure has been traditionally undertaken by doctors, but is a role that can be carried out by Advanced Nurse Practitioners (ANP) with appropriate training
●Considerable practice inconsistencies with the technique of the procedure, and timing of chest drain removal
OBJECTIVES
●Evidence-based protocol for the procedure to ensure consistency of practice by doctors and nurses
●High quality, timely, safe, effective care for all patients
The Protocol
●Discussion with ward Pharmacist and Consultant Thoracic Surgeon
●Literature search
●Presentation of protocol at QIPP’s
(Quality Innovation Productivity Prevention)
●Production of DOPS (Direct Observation
Procedural Skills) assessment form
DOPS ● Simple structured
checklist
● Commonly used for
medical trainees
● Practical skills
essential to provision of
good clinical care
DOPS Assessment Criteria
● Indications
● Anatomy
● Consent
● Technique, prep & post
procedure care
● Asepsis
● Communication
● Professionalism
Timing of Drain Removal after Talc Pleurodesis
● n=22
● Identified from pharmacy records
01/01/09 - 31/12/10
● Retrospective review of CXR’s,discharge
summaries and histology reports
● Effusion n=16 Pneumothorax n=6
Talc Pleurodesis performed for Pleural Effusion
Pleural Effusion n=16
Malignant n=15 Non-Malignant n=1
No Success n=1Success n=14 Success n=1
Talc Pleurodesis for Pneumothorax
Pneumothorax n=6
Success n=5 No Success n=1
CONCLUSION
●Talc Pleurodesis is a procedure which can be competently and safely performed by appropriately trained ANP’s.
- Audit patient satisfaction
●Evidence based protocol
●Guidelines disseminated for use Trust wide
●Apply similar process to other procedures as roles develop
REFERENCES
● Braithwaite W (2008) Performing Talc Pleurodesis in Patients with Mesothelioma Nursing Times 29th April: 1-6.
● Groth, G; Gatzemeier, U; Halibingen, K et al (1991) Malignant Pleural Effusion with Mitoxantrane Placebo (Pleural Tube Alone) Annals Oncology (2): 213-5.
● Medicines Information (2004) Management of Malignant Pleural Effusions-Pleurodesis Calderdale and Huddersfield NHS Trust.
● Morriston Hospital Pharmacy Department (2003) Talc Pleurodesis Swansea NHS Trust.
● Munday H, Rintoul R, Laroche, C, Buttery R, Hunter C and Lau-Walker, M (2007) Talc Pleurodesis:Doctor Versus Nurse Led Procedure. A Prospective, Randomised, Non-Inferiority, Multi-Centre Pilot Study J International Assoc Study Lung Canc 57(1):16.
● Nursing Practice Guidelines (2005) Guidelines for Pleurodesis via a Chest Drain Nottingham City Hospital/Queens Medical Centre/Rushcliffe PCT p1-6.
● Pharmacy Department and Respiratory Unit (2009) Protocol for Pleurodesis with Sterile Talc Lothian University Hospitals Division.
● Roberts M, Ali N, Neville E and Antunes G (2009) British Thoracic Society Guideline for the Management of Malignant Pleural Effusions British Thoracic Society 5th August:1-44.
● Tan, C; Swift, S (2006) The Evidence on the Effectiveness of Management for Malignant Pleural Effusion: a Systematic Review EJCTS (29): 829-838.
● Webb, WR; Ozmen, V; Moulder, PV et al (1992) Iodized Talc Pleurodesis for the Treatment of Pleural Effusions J Thorac Cardiovasc Surg 103:881-5.
● Weissberg, D; Ben-Zeev, I (1993) Talc Pleurodesis Experience with 360 patients J Thorac Cardiovasc Surg 106: 689-95.
Acknowledgements
Mr Mohammed Hawari
Cardiothoracic Registrar
for his help with this project