Authors (including presenting author) :
Ng SW(1), Karn KY(1), Wong LM(3), Fung TY(3), Tsui M(3), Cheung PS(3), Ho SM(3), Lee KY(2), Ng YB(3) Chan VL(3)
Affiliation :
(1)Nursing Services Division, United Christian Hospital (2)The Department of Community Nursing Service, United Christian Hospital (3)The Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
There is an increasing numbers of patients with recurrent malignant pleural effusions (MPE) receiving Indwelling Pleural Catheter (IPC). Repeated admissions due to malignant pleural effusions (MPEs) is common. IPC allows these patients to remain ambulatory outside hospital, fewer hospitalization days from treatment to death compared with talc pleurodesis. Additional advantages of IPCs include a low failure rate, improved quality of life, lower initial costs and a shorter initial admission time. Coordinated care has been provided for patients with IPCs from hospital to community for better continuity of care. This is a review on respiratory care for patients of MPE with IPCs in United Christian Hospital in 2019 for quality improvement.
Objectives :
To provide coordinated care for patients with recurrent MPEs receiving IPCs To review preliminarily the process and effectiveness of the care
Methodology :
Counselling and introduction would be provided to indicated and potential candidates for the issues of IPC including reasons, procedures, adverse effects & benefits of IPC as well as long-term care. Coordinated care was provided among in-patient, ambulatory and community nursing service. Primary nurse would be assigned for a IPC case to ensure better communication and care coordination. Carer and patient would be empowered for the long-term care of IPC. An educational booklet was developed to facilitate the care empowerment and communication. A competence checklist for carer was also developed to ensure carers fulfill the criteria for drainage procedure. Continuity of care would be enhanced with a hotline provided for better accessibility of healthcare. The cases recruited for insertion of IPCs in 2019 would be reviewed for quality improvement for the coordinated care. The review included patient’s basic demographic information, procedure or catheter related complications, adverse effects during the drainage procedures and their pattern of drainage.
Result & Outcome :
Coordinated care had been provided for Eight cases of IPC cared in our team in 2019. Four of them were reviewed and another four cases were not included for review due to the insertion of and follow up for IPCs in other public or private healthcare settings. There was three female and one male with mean age of 69.5 (63 to 83). All IPC was inserted IPC due to MPE with trapped lung and failed pleurodesis with three diagnosis of Carcinoma of breast with bone, lung and pleural metastasis and one carcinoma of lung. There was no procedure related complications. Also, there was no catheter related complications except that one case presented mild and occasional peri-catheter leakage in the first few days after the insertion of IPC. The drainage frequency and amount varied case by case from 275-915 ml each time and from every 2 to 6 days for drainage. All patients would present mild cough and chest pain during the drainage procedure. All patients and their carers expressed their thank for the service provided and being remained ambulatory outside hospital.
