Hi all! and chest tubes...

susanmary · Jun 21, 2003

I'm assuming you are referring to treating a recurrent pleural effusions with chemical pleurodesis. Chemical pleurodesis is often used to treat recurring pleural effusions which occur most often secondary to malignancies & also to prevent a recurring spontaneous pneumothorax. Basically, the goal is to form a symphasis between the parietal & visceral pleura -- obliterating the pleural space. (Sort of irritates the space between the parietal & visceral pleura so that it "sticks" together & fluid doesn't reaccumulate.)

Doxycycline is often used in chemical pleurodesis. In addition, antineoplastic agents such as bleomycin have also been used successfully in the treatment of malignant pleural effusions. Talc, has been shown to be highly effective as a pleurodesis agent in malignant pleural effusions. I've seen both bleomycin & talc used often with positive results -- but have no experience with antibiotics used. However, each time a doctor or physician's assistant injected the agent -- the chest tube would be clamped for a very specific amount of time, very specific position changes every 30 minutes, etc. The patient would need to be monitored closely, vital signs, sats, etc. -- watching closely for any shortness of breath, reaction to the instillation, etc.

This matter needs to be addressed with your nurse manager & nurse educator. Obviously, the nurse should not have instilled the antibiotic into the chest tube -- she had no training/validation & there were no policies/procedures for her to follow. The doctor certainly could have assumed responsibility & instilled the agent.

Hope this helps. Sue

Home Health Columnist / Guide · Jun 21, 2003

Agree with Susanmary 100%. I've posted some links with great info.

I've assisted the Docs many times when this was done at bedside. Postioning is key afterwards to get talc or other substance to as many areas as possible---done everthing except stand pts on their head, LOL

Today, I see many more pleurodesis being being done using VAT (video assisted thoractomy) in fluroscopy suite. Included link about Pleurx catheter as many of our homecare patients come home with one.

Chemical Pleurodesis for Malignant Pleural Effusion

Carolyn Clary-Macy, RN, OCN, UCSF Thoracic Surgery

http://www.cancersupportivecare.com/pleural.html

Chemical Pleurodesis for Pleural Effusions

http://www.vh.org/adult/provider/internalmedicine/PulmonaryCoreCurric/PleuralEffusion/05Chemical.html

PULMONARY CARE

Caring for Adults With Cystic Fibrosis

Debbie Wilmoth, Peggie E. Walters, Roy Tomlin, and Stacey F. McCray

http://www.critical-care-nurse.org/aacn/jrnlccn.nsf/(Articles)/213Col1?OpenDocument

Instilling Medications Via Chest Tubes ?

https://www.aacn.org/aacn/practice.nsf/0/35766580fe71c87b88256a800079ff42?OpenDocument

Thoracic Surgery Nursing Guidelines

Care of the Patient with a Pleurx Pleural Catheter

http://gseacademic.harvard.edu/~gilberpa/postdoc/analysis/topic1/pleurx.pdf