Indications
- Complicated Parapneumonic Effusion/Empyema (see Pleural Effusion-Parapneumonic)
Procedure
- Order From Pharmacy: sterile preparation of tPA 2 mg in 25 mL of saline in 70 mL catheter tip syringe
- Positioning: position patient in lateral position (side to be treated up)
- Chest Tube Clamps: apply two blue plastic chest tube clamps approximately 3 inches and 6 inches from end of the chest tube
- Disconnect Chest Tube: disconnect chest tube from pleurevac and hold chest tube end vertically
- Release of Distal Chest Tube Clamp: release distal chest tube clamp
- Instillation of tPA: instill part of tPA into chest tube (avoiding introduction of air)
- Release of Proximal Chest Tube Clamp: release proximal chest tube clamp
- Instillation of tPA: instill rest of tPA into chest tube (avoiding introduction of air)
- Instillation of Sterile Saline (pulled from bag of IV saline): instill 25 ml of sterile saline into chest tube, using same technique with chest tube clamps
- Reapplication of Chest Tube Clamps: reapply chest tube clamps and reconnect chest tube to pleurevac
- Chest Tube to Water Seal: place chest tube to water seal x 2 hrs (with patient positioned with treated side down, as tolerated)
- Return chest tube to suction after this 2 hr period
Complications
- Hemorrhage
- Infection
- Pneumothorax
References
- xxx