Patient safety warning issued over the rapid drainage of pleural effusion fluid from chest drains

Investigations revealed that staff did not always expect large quantities of pleural fluid to drain.

Matt Bodell
3 December 2020
Pleural Effusion

Two patients died due to unmonitored drainage of pleural effusions.

A joint National Patient Safety Alert has been issued by the NHS England and NHS Improvement National Patient Safety Team, British Thoracic Society (BTS) and Association of Respiratory Nurse Specialists (ARNS), on the risk of deterioration due to rapid offload of pleural effusion fluid from chest drains.


Pleural effusions are the accumulation of fluid between the lung and chest wall, which may cause breathlessness and low oxygen saturations.

Large effusions, such as those caused by pleural malignancy, may require insertion of a chest drain and controlled drainage of fluid to allow the lung to inflate.

The patient safety alert warns; “If large volumes of pleural fluid are drained too quickly, patients can rapidly deteriorate. Their blood pressure drops, and they can become increasingly breathless from the potentially life-threatening complication of re-expansion pulmonary oedema (RPO).

“This is due to a sudden re-expansion of the compressed lung with an accumulation of oedema within the lung(s).


“The rate at which fluid is drained must be controlled in order to prevent cardiovascular instability and collapse.”

Over a recent three-year period there have been 16 incidents where patients experienced acute and significant deterioration after uncontrolled or unmonitored drainage of a pleural effusion.

Two of these patients died and a cardiac arrest call was made for one patient although the outcome was not reported.

Investigations revealed that staff did not always expect large quantities of pleural fluid to drain, observations were either not timely or not done and plans to manage the rate of fluid drainage were not clearly documented.


The patient safety alert recommends that hospitals ensure continuous direct observation for the first 15 minutes after the insertion of the drain and guidelines should be followed ensuring controlled drainage of the fluid.

Red flags and an escalation plan should be communicated to the staff caring for the patient.

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