Chest Drains

Patient Emergency Response Team

Chest Drains
Anatomy & Physiology
Indications for use
Mechanisms of Action
Insertion
Do’s & Don’ts
Removal
 Anatomy of The Chest
Cavity Trachea

Intercostal
Muscles
Bronchi

Pleural Space
Ribs

Mediastinal
Area
Diaphragm
Mechanics of Breathing
Air Out

Relaxation of diaphragm
& intercostal muscles

↓-ve intrathoracic
pressure

Relaxation of the lungs

EXPIRATION
Mechanics of Breathing
Air 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 less
negative and water
level in the tube falls
NURSING CARE
Always 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