2.1 Staff & equipment
Seroma assessment and drainage is considered to be an expanded nursing practice within this Trust.
The Breast Care Team following training and competency based expanded practice assessment are then allowed to 'perform' this procedure.
The process for undertaking advanced practice is:-
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Supervised practice.
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Practice assessment.
Observed practice.
In line with NMC The Code 2015 (2) guidelines keep clear and accurate records relevant to your practice. There must be a current and appropriate plan of care for patients requiring seroma drainage. [2]
2.2 Method/procedure

Equipment required:
Trolley
50 ml luerlock syringe Disposable gloves
Disinfection wipe Disposable apron
21G needle / 16G cannula Inco sheet
3 way tap
Receiver
Dressing Tape
Gauze
Assess patient |
Ascertain "degree" of seroma and if this indicates drainage. |
Position patient comfortably usually in an upright sitting position on couch |
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Explain procedure to patient and obtain verbal consent. |
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Prepare equipment. |
Clinical - preference needle or cannula |
Wash hands |
Minimise risk of infection. |
Prepare dressing trolley with additional gauze. |
Ensure cleanliness is maintained. Be prepared for leakage of seroma fluid. |
Put on disposable gloves |
Be aware of contamination by seroma fluid. |
Prepare 50 ml syringe and 21G needle / 16G cannula and 3 way tap. |
Large bore needle/cannula facilitates aspiration. Large syringe and 3 way tap reduces disconnection required. |
Cleanse patients skin using disinfection wipe and allow to dry. |
Achieve full cleanliness. |
Insert needle/cannula into lower aspect of the seroma – at an angle of < 50 degrees. |
Gravity assists aspiration. Ensuring chest wall is not punctured. |
Aspirate seroma noting amount and type of fluid. |
Accurately record for progress and audit purposes. |
If seroma does not immediately aspirate – gently move needle/cannula within fluid. |
Seromas can be loculated. |
If aspiration is unsuccessful another puncture site can be used, maximum 3 attempts. |
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Use new needle/cannula for each further attempt. |
Maintain cleanliness. |
When aspiration complete cleanse skin of any seroma fluid leakage. |
Maintain cleanliness. |
Apply dry dressing – gauze and fix firmly. Arrange dressing to achieve some pressure. |
Pressure for 24 hours may assist skin flaps to adhere to chest wall and reduce further collection of lymphocele. |
Ensure patient feels comfortable. |
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Inform patient when to remove dressing and when to resume arm exercises and ascertain next appointment. |
Keep patient informed to reduce anxiety. |
Document on Somerset Cancer database. |
Maintain accurate records. |
If patients have any concerns at all they should contact the Breast Specialist Nurse.
2.3 Potential complications / Risk Management
Infection
The Breast Care Team may be able to detect infection within the seroma fluid. It is essential to observe the colour of the fluid drained. If the specimen is cloudy, send a specimen for culture and sensitivity and record in Somerset Cancer database. The patient or their general practitioner will need to be notified if antibiotics are appropriate or not.
If the patient experiences any difficulty in breathing after seroma drainage they should contact either the Breast Care Team, GP and A & E department. They may require a CXR and medical treatment.
2.4 After care
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The patient can remove the dressing later that day.
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The Breast Care Team will make the patient a further appointment for aspiration of seroma if required.
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The amount and type of fluid will be recorded on the Somerset Cancer database.