chest drains

Chest Drains

Patient Emergency Response Team

Anatomy & Physiology Indications for use Mechanisms of Action Insertion Do’s & Don’ts Removal

Chest Drains

Anatomy of The Chest Cavity Trachea

Bronchi

Ribs

Intercostal Muscles

Diaphragm

Mediastinal Area

Pleural Space

Mechanics of BreathingAir Out

Relaxation of diaphragm &

intercostal muscles

-ve intrathoracic pressure

Relaxation of the lungs

EXPIRATION

Mechanics of BreathingAir In

Contraction of diaphragm &

intercostal muscles

-ve intrathoracic pressure

Expansion of the lungs

Inspiration

Indications for a chest drain Following thoracic surgical

procedures Chest Trauma e.g haemothorax Pneumothorax

Types of Chest Drainage

Open drainage – drainage of small pockets of fluid e.g. empyema

Closed drainage – used to drain air and /or fluid from the pleural cavity.

Mechanism of Action – Closed drainage Use of an underwater seal Drainage occurs during expiration

due to +ve pleural pressure Air bubbles through the water seal

to the outside world The one-way mechanism prevents

air or fluid from entering the pleural space

Mechanism of Action Air flow is governed by the

relationship of interpleural pressure to atmospheric pressure

Drainage of air occurs during expiration when the pleural pressure is +ve i.e above atmospheric pressure

The water level in the tube will rise during inspiration when the pleural pressure is –ve i.e. below atmospheric pressure

Inspiration:

Negative intrapleural pressure causes water to rise up the tube

Expiration:

Intrapleural pressure is lessnegative and water level in the tube

falls

NURSING CAREAlways ensure underwater seal drain is primed with

water that covers the drainage tube

Initial observations post insertion 15 minutes for one

hour then hourly drainage observations for at least 4

hours.

Observations include whether the drain is bubbling or

draining or swinging which should be documented

Nursing care contd

If drain fails to bubble or drain or swing suddenly inform medical staff..this may be due to a blockage or the lung reinflating

If suction is required always use the special LOW VACCUM SUCTION UNIT at 5 kpa .

Place adhesive tape around the insertion site as well as any connections to prevent accidental disconnection.

Always place the drain in an easily visible position.

Never clamp the drain Only milk the drains if absolutely necessary. Always keep the drain below pts chest height

Insertion

Chest X-ray unless as an emergency procedure

Local anaesthetic using aseptic technique

Inserted in 5th intercostal space in mid-axillary line

Inserted over upper border of rib to avoid intercostal vessels & nerves

Insertion

Blunt dissection & insertion of fingers should ensure the pleural cavity is entered

Drain should be anchored & purse-string or Z-stitch inserted in anticipation of removal

Do’s & Don’ts

Avoid clamping of drain – this can result in a tension pneumothorax

Drain should only be clamped when changing the bottle

Always keep the drain below the level of the patient – if lifted above, the contents of the drain can siphon back into the chest

Do’s & Don’ts

If disconnection occurs reconnect & ask the patient to cough

If persistent air leak low pressure suction should be considered

Observe for post-expansion pulmonary oedema

Removal

The drain should be removed as soon as it has served it’s purpose

For a simple pneumothorax usually 24 hrs

To remove drain ask patient to perform a Valsalva manoeuvre

Removal

Remove drain at the height of inspiration

string or Z-stitch Perform a post-procedure chest x-

ray to exclude a pneumothorax

References:

www.surgical.tutor.org.uk Parry