The new outpatient model indwelling pleural catheter(IPC) insertion pathway success in NBH

ABSTRACT

Introduction/Aim: NBH is a new hospital with a public/private partnership without an established pleural disease management pathway for malignant effusion. A new outpatient model of management of IPC was established in January 2021 and we aim to assess the success of the new outpatient model indwelling pleural catheter(IPC) insertion pathway. Methods: The NBH outpatient pleural service started in Jan 2021. Initial IPC's insertions were carried on the ward with overnight hospital stay to educate the nursing staff and establish the outpatient pathways. Alternatively, for outpatients, insertions were performed in the procedure room and discharged following two-hour of clinical monitoring and a Chest X-Ray. Drainage bottles were funded either by the private health funds or arrangement with the hospital for public patients. The drainage in the community was carried out by Northern Sydney North Home Nursing Service with follow up the day after the procedure. All patients had threetimes a week drainage to start with followed by review at four weeks at the pleural clinic and decided on need for talc pleurodesis. If auto-pleurodesis was achieved the IPC was removed. Results: Between January - September 2021, 14 IPC inserted in our service ( Service was suspended for 3 months during COVID lock down period ). Nine patients had autopleurodeses by 4 weeks and IPC removed. Two died whilst the IPC is in-situ. Two had ongoing effusion past 4 weeks and it was changed to symptomatic drainage. Two patients had talc insertion via the IPC. Two had IPC after surgical (VATS) pleurodesis. None of the patients returned to the hospital following insertion of IPC for a pleural effusion related issue. No infections were reported. One accidental dislodgement of the IPC reported. Ward nursing staff had an education session 30mins after the first 3 insertions and refresher anytime an insertion is performed in the ward. Procedure room nurses were educated by the advance trainee. Over 80% patients were privately insured. Conclusion: The new outpatient model of IPC insertion in a new hospital with a public/private model was successful with auto-pleurodesis rate at high level and infection rates were low. The model was successful as majority of patients were privately insured and the hospital had to bear a minimal cost. The Northern Sydney North Home Nursing Service was vital to the success of the programme.