Review of patients discharged post thoracic surgery with chest drain in situ and nurse-based follow-up clinic

Submitted: May 1, 2023
Accepted: July 28, 2023
Published: September 4, 2023
Abstract Views: 560
PDF: 105
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Authors

Persistent air leaks and prolonged drainage are recognized complications of thoracic surgery, increasing hospital stay and costs. Patients can be discharged with a chest drain and followed up in a nurse-led clinic. We reviewed such patients and the rate of readmission after discharge to assess the effectiveness of the drain follow-up clinic. We conducted a retrospective review of our prospective database spanning 22 months, from March 2019 to January 2021. The analysis focused on the indication and duration of chest drainage, complications, and readmission for any reason. 62 patients (representing 5% of all thoracic surgery patients) were discharged with a chest drain. The median age was 67 years (range 22-85 years), with 24 females and 38 males. 52% underwent video-assisted thoracoscopic surgery, 27% had a thoracotomy, and 21% had bedside chest drain insertion. Following discharge, the median duration of chest drainage was 11 days [interquartile range (IQR) 7-18.75 days]. Patients had 106 review episodes in the ward-based nurse-led clinic. The indications were prolonged air leak (71%; 72 clinic reviews), persistent fluid drainage following empyema evacuation (16%; 24 clinic reviews), and persistent fluid drainage for simple effusion (13%; 10 clinic reviews). The median length of drain stay was 30 days (IQR 19.75-54 days) for empyema, 10 days (IQR 6-16 days) for air leak, and 8 days (IQR 6.5-12 days) for simple effusion. 9 patients required readmission (14.5%), and empyema had developed in 3 patients (4.8%). Patients discharged with a chest drain in place can be followed up in a dedicated ward-based nurse-led monitoring clinic for optimal quality of care.

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Citations

Tcherveniakov P, De Siqueira J, Milton R, Papagiannopoulos K. Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety. Eur J Cardiothorac Surg 2012;41:1353-6.
Reinersman JM, Allen M, Blackmon S, et al. Analysis of patients discharged from the hospital with a chest tube in place after thoracic surgery. Interact Cardiov Th 2016;23:i40.
Fuller M, Smith JS. Research proposal -- outpatient chest tube management following thoracic resection improves patient length of stay and satisfaction without compromising outcomes. 2012. Available from: https://knowledge.e.southern.edu/gradnursing/13.
Menna C, Ibrahim M, Poggi C, et al. Outpatient chest tube management. J Xiangya Med 2018;3:12.
Williams S, Williams J, Tcherveniakov P, Milton R. Impact of a thoracic nurse-led chest drain clinic on patient satisfaction. Interact Cardiov Th 2012;14:729-33.
Scarci M, Solli P, Bedetti B. Enhanced recovery pathway for thoracic surgery in the UK. J Thorac Dis 2016;8:78-83.

Ethics Approval

This study was approved by the quality and audit department at Royal Victoria Hospital, Belfast on 16th February 2021 with the reference number 6347.

How to Cite

Aljanadi, Firas, Jonathan Strickland, Liana Montgomery, and Mark Jones. 2023. “Review of Patients Discharged Post Thoracic Surgery With Chest Drain <i>in situ< i> And Nurse-Based Follow-up Clinic”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2624.

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