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Chest Drains: Consumer summary: 26/11/2010

Schneller, Lea-Ellen BPharm FACPP

doi: 10.1097/01.JBI.0000395923.77507.4a
Departments: Evidence in Action: Recommended Practice
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Who is this for?

The purpose of this information sheet is to summarise previous research and present the best available evidence on chest drains. A chest drain is a fine plastic tube that is inserted into the space between your lungs and the membranes covering them, to allow your lungs to inflate. A chest drain is inserted to remove air or fluids, such as blood, lymph or pus that have accumulated in the pleural space, crowding the lungs. This air or fluid may be due to surgery, illness, or trauma. Normally the pleural space contains a small amount of lubricant. You may need a chest drain if you have a pneumothorax (air outside the lung), a fluid build up, pus from empyema, blood in your chest because of heart or chest surgery, or because of trauma from a chest wound.

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What We Know

The principle purpose of chest drains is to maintain your lung function and a stable blood supply. Correct placement of the chest drain is vital. Incorrect placement can lead to serious complications, so only specially trained medical personnel are competent to insert a chest drain.

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Chest drain insertion

Inserting the plastic tube for a chest drain uses sterile apparatus and a special drain bottle with an underwater seal. The seal functions to contain the air, fluid or pus, which drains from your chest. The drain bottle is kept below you to ensure that no backflow of fluid can occur.

Before a chest drain is inserted the procedure will be carefully explained to you:

1. The chest tube will be inserted in a safe triangular area between your ribs, under your arm.

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2. The area will be swabbed with antiseptic then numbed with a local anesthetic.

3. Medication may be given to help you relax and to reduce pain.

4. The chest tube is then inserted through a small blunt incision (cut) between your ribs.

5. The tube is connected to a pre-prepared underwater drainage system containing sterile water and suction may be attached to assist drainage.

6. The tube is taped in place so it cannot move.

7. The closed drainage bottle and sterile tubing will be carefully secured to avoid kinking and allow drainage.

8. You will have a chest x-ray to check on correct tube placement.

9. You will then be assisted to perform chest and arm exercises provided by a physiotherapist.

You will be monitored carefully while you have a chest drain in place.

1. The character and quantity of drainage will be checked. If your drain is in the pleural space draining air, the nurse will check for oscillation (swinging of fluid in rhythm with your breaths) and for bubbling of air.

2. Frequent observations of the tubing will be made to ensure drainage is continuing and to check for: kinks, flattening and blockage in the tubing, loosening of connections, tube dislodgement or dependent loops.

3. Your clinical state will be monitored. All aspects of your breathing, your heart rate, your temperature and the level of oxygen in your blood will be monitored.

4. The tubing from your chest drain should not be clamped if you need to be transported. If transport is necessary, it is important that the bottle is carried below the level of the chest drain and observed for safety at all times.

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The Evidence Suggests...

The procedure for inserting chest drains that is used to treat lung collapse from causes such as lung abscesses, after trauma or surgery, air in the chest (pneumothorax), or blood in the chest (hemothorax) has some risks. These can be minimised by using only properly experienced medical personnel, and following procedures carefully with full aseptic precautions in order to avoid infection of the wound site.

* If you have any blood clotting difficulties it is recommended that these are corrected before the chest drain is inserted.

* Appropriate positioning for chest drain insertion (on your side with your arm raised or leaning forward) will depend on the reason for insertion, and your clinical state.

* Where possible small calibre drains are better tolerated and more comfortable than larger calibre drains.

* Your vital signs should be monitored at least every 4 hours while you have a chest tube in place.

* The insertion site of your chest drain should be checked daily and should be clean, dry and free of odour. The site should be assessed for air infiltration (subcutaneous emphysema) and the chest drain should be monitored for swinging and/or bubbling and drainage.

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Evidence Reliability

The evidence related to the topic of each consumer publication produced by the Joanna Briggs Institute is assessed for reliability and quality. We do not rate a procedure or treatment, but the evidence (or research) that is available to support it. Evidence can play a critical role in any investigation and it is important for detectives to recognise evidence that will provide ‘reliable’ information to aid in the investigation.

This is also the case when assessing health information, as some types of evidence are more reliable than others. For Joanna Briggs Institute evidence based information for consumers, you can be assured that the best available evidence is utilised. If you would like more information about research and levels of evidence, please contact the Joanna Briggs Institute or visit the research page of our consumer web site.

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“The procedures described in this pamphlet must only be used by people who have appropriate expertise in the field to which the procedure relates. The applicability of any information must be established before relying on it. While care has been taken to ensure that this pamphlet summarises available research and expert consensus, any loss, damage, cost, expense or liability suffered or incurred as a result of reliance on these procedures (whether arising in contract, negligence or otherwise) is, to the extent permitted by law, excluded”.

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What is Evidence-Based Health Information?

Just as a detective searches for evidence to solve a crime, so too do health professionals look for evidence to guide their practice. The detective must have evidence to support their case. In a similar fashion, the health care professional must have evidence to support their proposed course of treatment. They search for information that will help them to provide the most effective or beneficial form of care to their patients. Due to the wealth of information available to them, the process of discovering which information is the best can be difficult and time consuming. It would take an enormous amount of time for your doctor to sift through the large amounts of research and information available to them on a particular topic. This is where the Joanna Briggs Institute comes into play. We conduct the ‘detective’ work, providing them (and you) with the best available evidence.

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What does this mean for consumers?

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As consumers of health care it is important to know that your treatment is being based on the best available evidence. It is also important that you are provided with all of the information in order to have greater independence in relation to your own health care decisions and to be involved in the decision making process.

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Further Information

The Joanna Briggs Institute Consumer Information Program provides up to date literature reviews to ensure your information is based on the best available evidence. The Institute also produces systematic reviews and Best Practice Information sheets aimed at clinicians and health professionals. This means you are provided with the same high standard of publications based on the same information as those working directly in the field.

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JBI, Evidence Summary: Chest Drains: Insertion, JBI Database of Evidence Summaries, 2009.
JBI, Evidence Summary: Chest Drains: Monitoring, JBI Database of Evidence Summaries, 2010.
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Chest Drains: Monitoring

Recommended Practice
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Recommended Practice

1. Check the character and quantity of drainage. If drain is in the pleural space draining air, check also for oscillation (swinging of fluid in rhythm with the patient's respirations) and for bubbling of air.

2. Frequent observations should be made for:

* kinks in the tubing

* flattening of tubing

* loosening of connections

* blockage of tubing

* tube dislodgment

* dependant loops

3. Monitor patient's clinical state:

* breath sounds and equality

* respiration rate

* respiratory pattern and effort and depth

* heart rate

* temperature

* oxygen saturation

4. Tubing should not be clamped for transport of patient. If transport is necessary, ensure the bottle is carried below the level of the patient and observe for safety at all times.

© 2011 Lippincott Williams & Wilkins, Inc.