Is the offload rate of pleural effusion from chest drain controlled? (National Patient Safety Alert)

Abstract

Pleural effusions are the accumulation of fluid between the lung and chest wall, which may cause breathlessness, low oxygen saturation and can lead to collapsed lung(s). Common medical problem with over 50 recognised causes and various treatments. Large effusions may require insertion of a chest drain and controlled drainage of fluid to allow the lung to inflate. If large volumes of pleural fluid are drained too quickly, patients can rapidly deteriorate and cause re-expansion pulmonary oedema (RPO). Sudden re-expansion of the compressed lung with an accumulation of oedema within the lung(s). Rate at which fluid is drained must be controlled in order to prevent cardiovascular instability and collapse. Review of the National Reporting and Learning System (NRLS) over 3 year period Identified 16 incidents with significant patient deterioration after uncontrolled or unmonitored drainage Two patients died and a cardiac arrest call was made for one patient although the outcome was not reported.