A joint National Patient Safety Alert has been issued by the NHS England and NHS Improvement National Patient Safety Team, British Thoracic Society (BTS) and Association of Respiratory Nurse Specialists (ARNS), on the risk of deterioration due to rapid offload of pleural effusion fluid from chest drains.
- National Patient Safety Alert – Deterioration due to rapid offload of pleural effusion fluid from chest drains
About this alert
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). Large effusions, such as those caused by pleural malignancy, 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. Their blood pressure drops, and they can become increasingly breathless from the potentially life-threatening complication of re-expansion pulmonary oedema. The rate at which fluid is drained must be controlled in order to prevent cardiovascular instability and collapse.
The alert asks providers to review local chest drain clinical procedures to ensure they follow BTS and ARNS guidelines and standards; and to ensure clear instruction on frequency of observation, red flag triggers and local escalation procedures for patient deterioration are available to staff at the patient’s bedside.