• Chelsea Miller, Elizabeth Bridges, Balaji Laxmanan, Paula Cox-North, and Hilaire Thompson.
• Chelsea Miller is Advanced Practice Provider Clinical Resident, Emory Healthcare, 1364 Clifton Road, Atlanta, GA 30322 (chelsea.b.miller@emoryhealthcare.org). Elizabeth Bridges is Professor, University of Washington School of Nursing, Seattle, Washington. Balaji Laxmanan is Director, Interventional Pulmonology, Confluence Health, Wenatchee, Washington. Paula Cox-North is Lecturer, University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Informatics, Seattle, Washington. Hilaire Thompson is Joanne Montgomery Endowed Professor and Lead, Adult/Gerontology Acute Care Nurse Practitioner Program, University of Washington School of Nursing, Seattle, Washington.
• AACN Adv Crit Care. 2018 Jan 1; 29 (4): 432-441.

AbstractRecurrent pleural effusion is a symptom of several end-stage diseases and is associated with limited life expectancy. Patients with this condition have disabling symptoms resulting in reduced quality of life and often receive inconsistent treatment due to delayed recognition of pleural effusion, repeat procedures, and lengthy hospitalizations. Placement of a tunneled pleural catheter allows the patient to manage his or her symptoms at home, yet this treatment remains underused because of provider misconceptions and unfamiliarity with the intervention. This article provides an overview of the indications for placement of a tunneled pleural catheter, possible complications, and management strategies, and introduces evidence-based clinical decision support tools to enhance provider knowledge. In addition, the article describes the implementation and evaluation of a performance improvement initiative on the use of tunneled pleural catheters in a multifaceted health care system.©2018 American Association of Critical-Care Nurses.

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