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Originator: National Patient Safety Alert - NHS England & NHS Improvement

Issue date: 01-Dec-2020 10:00:06

This alert has been issued to:
  • Care Trusts
  • Mental Health Trusts
  • Specialists Trusts
  • Learning Disabilities Trusts
  • Mental Health & Social Care Trusts
  • Ambulance Trusts
  • Mental Health & Learning Disabilities Trusts
  • Acute Trusts
  • Community Trusts

  • Other contacts
  • Independent Healthcare Providers (registered with CAS)
  • Clinical Commissioning Groups
  • Special Health Authorities

Action category: Immediate Action

Title: Deterioration due to rapid offload of pleural effusion fluid from chest drains

Broadcast content:

If large volumes of pleural fluid are drained too quickly from chest drains, patients can rapidly deteriorate from the potentially life-threatening complication of re-expansion pulmonary oedema. The rate at which fluid is drained must be controlled in order to prevent cardiovascular instability and collapse.

Providers are asked to review local chest drain clinical procedures to ensure they follow national guidelines and standards; and to ensure clear instruction on frequency of observation, red flag triggers and local escalation procedures for patient deterioration are available at the patient’s bedside.

Additional information: This alert is not relevant to primary care.

Alert reference: NatPSA/2020/008/NHSPS

Action underway deadline: 04-Dec-2020

Action complete deadline: 01-Jun-2021


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Email: safetyalerts@mhra.gov.uk

Medicines and Healthcare products Regulatory Agency