Note: This guideline is currently under review. Show
IntroductionChest drains also known as under water sealed drains (UWSD) are inserted to allow draining of the pleural spaces of air, blood or fluid, allowing expansion of the lungs and restoration of negative pressure in the thoracic cavity. The underwater seal also prevents backflow of air or fluid into the pleural cavity. Appropriate chest drain management is required to maintain respiratory function and haemodynamic stability. Chest drains may be placed routinely in theatre, PICU and NICU; or in the emergency department and ward areas in emergency situations. AimTo describe safe and competent management of (UWSD) chest drains by the health care team. Definition of termsChylothorax: Collection of lymph fluid in the pleural space Haemothorax: Collection of blood in the pleural space Pneumothorax: Collection of air in the pleural space Tension Pneumothorax: One way valve effect which allows air to enter the pleural space, but not leave. Air builds up and forces a mediastinal shift. This leads to decreased venous return to the heart and lung collapse/compression causing acute life-threatening respiratory and cardiovascular compromise. Ventilated patients are particularly high risk due to the positive pressure forcing more air into the pleural space. Tension pneumothorax can result in rapid clinical deterioration and is an emergency situation Pleural effusion: Exudate or transudate in the pleural space Under Water Seal Drain (UWSD): Drainage system of 3 chambers consisting of a water seal, suction control and drainage collection chamber. UWSD are designed to allow air or fluid to be removed from the pleural cavity, while also preventing backflow of air or fluid into the pleural space Flutter valve (e.g. Pneumostat, Heimlich valve): One way valve system that is small and portable for transport or ambulant
patients. Allows air or fluid to drain, but not to backflow into pleural cavity. Indications for Insertion of a Chest Drain
Insertion of a Chest DrainSee the Chest Drain (Intercostal Catheter) Insertion Clinical Practice Guideline. RCH access only: See Aseptic Technique Policy and Procedure Chest Drain Set Up
ManagementChest drains should not be clamped unless ordered by medical staff There is a risk of the patient developing a tension pneumothorax if a drain is clamped while an air leak is present Start of shift checks
Patient Assessment
Pain
Drain insertion site
Assessment of chest tube and system tubing should occur at the beginning of the shift and every hour throughout the shift UWSD Unit and tubing
Suction
Drainage
Air Leak (bubbling)
Oscillation (swing)
Equipment by the bedside
Other Considerations
Patient Positioning
Patient Transport
Specimen CollectionCollect drainage specimens for culture through the needless sampling port located by the in line connector. Equipment Required
Procedure:
Chest Drain DressingsDressings should be changed if:
Exact type of dressing may depend on treating medical team For cardiac surgical patients with drains inserted intraoperatively:
For all other chest drains:
Ensure drain is secure
Removal of Dressings
Changing the Chamber
Procedure
Splitting the UWSD Chambers
Procedure (also see figure below)
Removal of Chest DrainsThere must be a written order by medical staff in EMR Indications
Equipment required
Patient preparation
Procedure
Post Procedure Care
Complications and TroubleshootingPneumothorax
Bleeding at the drain site
Infection of insertion site
Accidental disconnection of system
Accidental drain removal
Purse string cut or not present
Unable to remove chest drain
Retained drain during removal
Family Centred Care
Companion Documents
References
Evidence Table
Please remember to read the disclaimer The development of this nursing guideline was coordinated by Daniel Wall and Grace Larson, Rosella PICU, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2016. What are potential complications when a patient has a chest tube?In general, chest tube complications are categorized as insertional, positional or infective. More specifically, pain, vascular injury, improper positioning of the tube, inadvertent tube removal, postremoval complications, longer hospital stays, empyema and pneumonia have been reported in up to 30% of cases.
What are the complications of chest drainage?Further, the article deals with the most common complications of chest drainage, namely prolonged air leak, multifactorial lung oedemas, atrial fibrillation and empyema of the chest cavity.
What are safety considerations when caring for a patient with a chest tube?Never lift drain above chest level. Never lift drain above chest level.. The unit and all tubing should be below patient's chest level to facilitate drainage.. Tubing should have no kinks or obstructions that may inhibit drainage.. Ensure all connections between chest tubes and drainage unit are tight and secure.. How does a closed drainage system chest tube work?Closed chest drainage systems use gravity and/or suction to restore negative pressure and remove air, fluid, and/or blood from the pleural space so that the collapsed lung can re-expand.
|