DDHHS Pleural Procedures Report

Patient Details

Location

Procedure Types

Date of Procedure:

Procedures Performed:

Select from list below

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Indications

Principle Indication:
Indication notes:

Medications Administered Click to add medications

Pre Procedure

Laterality:
Aspect:
Site notes:
Antisepsis:
Local anaesthetic needle aspirate:

Ultrasound

Post Procedure Management

CXR required:
Remove sutures in 5 days:
Notify dyspnoea or any concerns:
Additional notes:

Post ICC Obs

Limit ICC drainage to 1000mL per hour:
Initial ICC Obs:		hourly
Initial obs duration:		hours or until drainage less than 1000mL/hr (whichever is longer).
Subsequent Obs:		hourly
Standard obs are: RR, SpO2, BP, HR, Temp, pain score, dyspnoea score, dressing, tubing and connections, swing, leak, drainage fluid volume, fluid characteristics, suction, and subcutaneous emphysema,

Images

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Thoracocentesis kit:
Total volume fluid removed (mL):
Volume fluid sent to pathology (mL):
Thoracocentesis notes:

Biopsy type:
Real-time ultrasound guidance:
Number of passes:
Biopsy depth (mm):
Biopsy notes:

Yes No	Microscopy, culture & sensitivity.	Yes No	Protein.
Yes No	Acid fast bacilli smear and culture.	Yes No	Glucose.
Yes No	Cytology.	Yes No	LDH.
Yes No	Cell count and differential.	Yes No	pH.
Yes No	Histopathology.	Yes No	Adenosine deaminase.
Yes No	ThinPrep for NGS.	Yes No	Other.

Consent type:		Consent obtained from:
Additional notes regarding consent:

Complications:
Complication notes:

Catheter remove:
Dressing applied: