What is Thopaz+?

Thopaz+ is a portable, digital chest drainage and monitoring system. Its supplier is Medela UK Ltd.

In accordance with MTFM criteria, NICE has published Medical Technologies Guidance for Thopaz+ (MTG 37) which states, “Thopaz+ should be considered for people who need chest drainage after pulmonary resection or because of a pneumothorax.”

Pulmonary resection is a surgical procedure to remove part or all of the lung. This is usually performed to remove diseased lung tissue such as cancerous or emphysematous areas.

Pneumothorax is a collection of air in the pleural space, between the lung and the chest wall resulting in a collapsed lung. When this occurs in healthy people with no underlying lung disease it is termed ‘Primary Spontaneous Pneumothorax’ (PSP). When it occurs in people with an underlying lung disease, it is termed ‘Secondary Spontaneous Pneumothorax’ (SSP).

Why is Thopaz+ required?

When a chest drain is used to drain the air (or fluid, collectively termed a pleural effusion) a tube is often inserted through the chest wall into the pleural cavity – an intercostal chest drain – and connected to a conventional underwater seal chamber. This prevents backflow of the air into the pleural space, which is a negatively pressured cavity.

Air leak is then monitored by the time-consuming and subjective method of observing for air bubbles in the underwater seal chamber. The more bubbles the higher the rate of air leak.  Given the subjectivity of this method, the decision to remove the chest drain safely often requires a senior decision maker.

Similar time-consuming methods are required to manually monitor the rate of fluid drainage. Hence it is difficult for clinical staff to know when it is safe to remove the chest drain tube, often erring on the side of caution. Furthermore, when suction is applied these conventional underwater seal drainage systems require patients to remain in bed, which can lead to increased length of stay in hospital.

Smoking and pneumothorax

According to the Office for National Statistics (ONS), people living in the most deprived communities are four times more likely to smoke than those in the least deprived communities. Chronic respiratory disease (CRD) including COPD is linked to smoking status and is also a risk factor for secondary spontaneous pneumothorax. Hence, CRD is a clinical area of focus as part of the Core20PLUS5 initiative.

What solution does Thopaz+ provide?

Thopaz+ is a chest drainage system with a digital display of objective data on rate of air leak, rate of fluid drainage and air pressure. The system allows the patient to be monitored via the digital readings of the amount of air and fluid drained and air pressure. The digital monitor helps clinicians to identify the optimal time to remove the chest drain tube.

Thopaz+ has therefore been demonstrated to provide several benefits over conventional underwater seal drainage systems including:

• Aiding clinical decision making – accurate readings of air leakage among nurses, surgeons and physicians regardless of experience level due to the objective nature of the digital system.
• Safety – as aforementioned, using a digital chest drainage system can aid the planning of and adherence to a safe chest tube removal policy given the objective data provided.
• Reduced length of stay – a significant reduction in length of hospital stay with digital chest drains when compared to conventional, underwater seal chest drains.
• Patient recovery – As Thopaz+ is a mobile device it allows for earlier patient mobilisation and quicker recovery compared to conventional, underwater seal chest drains.
• Cost effectiveness – cost savings of £111 per patient per hospital stay are reported for Thopaz+, mainly through reduced length of stay as per NICE cost modelling.

As part of the Medical Technologies Guidance for Thopaz+, NICE has produced a case study on Thopaz+, which had the following key findings:

• The Thopaz and Thopaz+ devices provide better information for managing patients – 3 days’ worth of data on air leak and fluid loss.
• Patients can mobilise earlier following surgery.
• Nurses find reading the result easier than counting bubbles.

You can see the full case study on the NICE website for MTG37.

Find out more

If you are interested in implementing Thopaz+ or for more information and resources contact the Health Innovation Network National Lead for Thopaz+, Joe Robinson.

NHS or Health Innovation Network staff can see more on the NHS Futures website. Contact Joe for details.