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Aspira Drainage System Discharge/Prescription Form

Aspira Drainage System Discharge/Prescription Form 2025

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The document is an Aspira Drainage System Discharge/Prescription Form used for patients requiring drainage supplies and catheter placement. It includes sections for patient information, discharge destination, quantity of supplies, primary and secondary diagnoses, drainage and dressing prescriptions, length of need, physician attestation, and insurance verification. The form ensures proper documentation and compliance for the use of Aspira products in patient care.

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2019	4.5 Satisfied (27 Votes)
2018	4.9 Satisfied (40 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is aspira drain a chest tube?

Your doctor has put an Aspira Drainage Catheter in your chest or abdomen to drain fluid in those areas. The catheter lets you drain fluid at home. Fluid drainage can help prevent or reduce shortness of breath or other symptoms.

What is an Aspira drain for pleural effusion?

The Aspira Drainage System is a tunneled, long-term catheter used to drain accumulated fluid from the pleural or peritoneal cavity to relieve symptoms associated with pleural effusion or malignant ascites.

What is the purpose of the Aspira drain?

This drain is a soft silicone tube with many holes on one end. This is placed where fluid collects in your belly or lungs. The tube allows the fluid to drain out of your body and into a drainage bag.

What are the complications of Aspira drain?

Some risks of using the Aspira Drainage Catheter include: Infection (watch for fever, redness, and oozing at your drain site) Collapsed lung. A leak around the drain.

What is the difference between PleurX drain and Aspira drain?

For pleural fluid drainage, the PleurX catheter uses vacuum collecting bottles while the Aspira catheter has a manual pump to facilitate collection in a bag. Fluid production can decrease over time with spontaneous pleurodesis occurring eventually, and then the IPC can be removed.

Key Facts about the Aspira Drainage System Discharge/Prescription Form

Patient Information Required

Discharge Options Available

Supply Quantity Selection

Diagnosis Specification

Prescription Details for Kits

Length of Need for Supplies

Physician Attestation Required

Patient Information Required

The form requires essential patient details including name, date of birth, phone number, and time zone.

Discharge Options Available

Patients can be discharged to various settings such as home, home health nurse, hospice, or a skilled nursing facility (SNF).

Supply Quantity Selection

The form allows selection of the quantity of Aspira drainage system supplies to be sent home with the patient, ranging from 0 to 20 drainage/dressings.

Diagnosis Specification

Primary and secondary diagnoses must be specified using ICD codes related to fluid locations and medical conditions requiring catheter placement.

Prescription Details for Kits

Prescriptions for both Aspira Drainage Kit and Dressing Kit must specify usage frequency; options include daily or every other day.

Length of Need for Supplies

The form allows for specifying the length of need for supplies, with options ranging from 3 months up to a maximum of 12 months.

Physician Attestation Required

A physician's signature is required to certify that the information is accurate and that the patient has been trained on proper use of prescribed products.

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