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