chest drains
TRANSCRIPT
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