Traditional models of care utilise the skills of a doctor to perform Therapeutic Pleural Aspiration (TPA). The procedure is often unplanned, rushed and performed by training doctors requiring supervision. At Salford Royal NHS Foundation Trust, we have trained the UKs first Lung Cancer Advanced Practitioner Nurse (LCAPN) to carry out TPA, as a bridge to alleviating chest symptoms prior to initiation of more definitive anti-cancer treatment and/or pleurodesis or as part of Best Suportive Care. From April 2009 to July 2010, our LCAPN carried out 41 planned TPAs independently in 23 individual patients with cancer related pleural effusion (11 lung cancers, 6 mesotheliomas, 6 other primaries) on the day ward, producing a total of 53 327 ml of fluid (mean 1300 ml). Patients were identified as suitable for TPA by the Lead Lung Cancer Clinician who used results from CT scan or same day Thoracic ultrasound scan to guide optimal site for needle placement using local anaesthesia (LA). Fluid was removed using the TRU-CLOSE suction drainage system. At the end of each procedure, patients were asked to complete a self-administered questionnaire based on their experience of the procedure, process of consent and comfort. Overall, the service was rated as excellent by 100% of patients. In particular, the service was rated highly for scheduling of TPA, information giving, consent, comfort and ability of LCAPN to perform the procedure. 76% of patients experienced either no pain or only mild discomfort and 21% experienced moderate discomfort, although this generally occurred at the end of the procedure.
Conclusion Nurse led TPA for cancer related pleural effusion is an acceptable model of care for alleviating symptoms prior to more definitive anti-cancer treatment or as part of Best Supportive Care.