CPD practice profile

Chest drainage A CPD article reinforced Chris Carter’s knowledge of the care required for a patient with an intrapleural chest drain As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD article useful in reviewing the pathophysiology of a pneumothorax, use of intrapleural chest drains, observations that should be recorded, and nursing care and management of a patient with an intrapleural chest drain. Reflecting on the time out activities in the CPD article was valuable. A time out activity prompted reflection on equipment used in military and civilian settings. This activity was useful because I work in several settings with different equipment, protocols and patient groups. The nature of military operations means chest drains are often inserted because of trauma. The drains that are used tend to be wide bore and connected to portable collection bags. Special pre-packaged chest drain sets are used in pre-hospital, emergency and critical care units in field hospitals; however, it is possible

to use underwater seal bottles in larger field hospitals. A time out activity prompted a review of guidelines in my clinical area. Clinical Guidelines for Operations (Ministry of Defence 2012) contains specific sections on recognition and treatment of a spontaneous pneumothorax, tension pneumothorax and haemothorax. These guidelines highlight the features of the conditions, immediate actions to be taken and care required. However, the guidelines do not cover elements such as optional dressings and removal of drains. Initially a drain site may be

This practice profile is based on NS696 Woodrow P (2013) Intrapleural chest drainage. Nursing Standard. 27, 40, 49-56.

well-padded to prevent drain dislodgement during patient evacuation. An over-padded drainage site may restrict breathing and prevent inspection. Another time out activity prompted development of care plans for a ventilated patient and for a high dependency patient. Although the principles of caring for a patient with an intrapleural chest drain are similar in both these cases, the ventilated patient presents additional challenges such as recognising and managing pain and repositioning the patient with multiple invasive catheters. This time out activity assisted in consolidating all such elements. After reading the CPD, I have been reminded of the nursing interventions required to care for a patient with an intrapleural chest drain and this prompted a review of current evidence and literature on this topic. This will be used to benefit my practice in the UK and overseas. I used the time out activities to meet the defence operational nursing competencies. I used the CPD article at my unit’s Journal Club to share practice with colleagues and review guidance related to intrapleural chest drains NS Chris Carter is an intensive care nursing officer in the British Army, and at the time of writing worked at 16 Medical Regiment Reference Ministry of Defence (2012) Clinical Guidelines for Operations. Joint Service Publication JSP 999. kxrhodt (Last accessed: June 20 2014.)

Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 51 for this week’s article and on page 62 you can find out how to present and submit your reflective account.

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Chest drainage.

As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD articl...
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