Pleurx drains

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Hi- just wondering if anyone can help/enlighten me.

I am a HH nurse and have taken care of many patients with pleurx drains, so I am very comfortable with the use of them as well as possible side effects/complications/expectations for the patients during.

So, one of my patients had the drain placed in the LLL earlier this week, Friday was our first time draining in the home. Towards the end of the draining she suddenly screamed out in severe pain, abdominal cramping. Coughing, chest pain, etc is what I've seen, never abdominal cramping. I clamped her and we waited for it to subside, restarted very slowly but it came back immediately and as severe so we ended it.

I called the surgeon to inform and sought out a rationale, the NP said it was normal but was brushing over it when I asked why that would happen.

Can anyone enlighten me? Has anyone else seen this occur? My patient was in agony.

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Since the drain is around the LLL and further down towards the abdomen this could seem like abdominal pain to the pt when really it is indeed chest pain. How much did you take off when the pain started? This was the pts first time using the pleurx correct? If they haven't had multiple higher volume thoracenteses (spelling?) they may have never experienced the pain of lung re-expansion.

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Yes, perhaps she did confuse the abd/LLL, though she pointed to her mid abdomen when I asked her to show me where it hurt.

I had taken off ~450ml when she screamed out and yes, it was the 1st time it was done (aside from the initial insertion where they took off 500ml but I think she was under conscious sedation). I'm going again tomorrow and just hate not understanding why I am causing someone so much pain.

Thanks for your thoughts though, I appreciate any rationale.

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Oh that makes a lot of sense now. I wouldn't feel bad about it as it's inevitable. I would just educate the pt about pain associated with lung re-expansion before you begin. As least she'll understand why it needs to be done and you are not intentionally hurting her.

You could also try taking off say 200mL, take a little break and then finish draining the remaining fluid. It'll still be uncomfortable but maybe more manageable? Does it have a roller clamp to slow the rate of the flow?

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Specializes in Cardiology, Oncology, Hospice,IV Therapy.

She should also premedicate with pain medication if she has any prior to draining her and do it slowly.

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She should also premedicate with pain medication if she has any prior to draining her and do it slowly.

Exactly, I would (and have in the past) requested the surgeon prescribed something PRN for pain and/or anxiety prior to the draining for a few weeks.

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Specializes in Critical Care.

Going slow only prolongs the pain, it doesn't generally reduce it's severity, the patient experiences the same pain just for a longer period of time. In a HH setting premedication is not always practical, a bit of fentanyl is the ideal medication for this but it's not particularly common for HH nurses to be allowed to carry around IV fentanyl or for the patient with just a pleurx to have long term IV access.

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Going slow only prolongs the pain, it doesn't generally reduce it's severity, the patient experiences the same pain just for a longer period of time. In a HH setting premedication is not always practical, a bit of fentanyl is the ideal medication for this but it's not particularly common for HH nurses to be allowed to carry around IV fentanyl or for the patient with just a pleurx to have long term IV access.

When I worked HHC we would always schedule the drains for the first appointment, or the last of the day. Patients knew to take whatever PO med they had for pain 45 minutes before we were scheduled to arrive. It was the best we could do.

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