Learning Zone

Chest Drainage

The chest drain is required when a patient has an air leak (pneumothorax), a collection of fluid (pleural effusion) or a collection of pus (empyema) in the pleural space. Any of these can cause problems with breathing and can stop the lungs from working properly. The chest drain will allow the fluid or air to leave the body and allow the lungs to re-expand.

A chest drain is a narrow tube that is inserted and sits in the space between the lung and the chest wall. This space is lined on both sides by a membrane called the pleura and is known as the pleural cavity or pleural space.

A chest drain is inserted when air, fluid or pus has collected in the pleural space.

The external end of the chest drain tube is attached to a bottle containing water which acts as a seal to prevent air from leaking back into the pleural space.

Working of a Chest Drain:

Once a chest drain is inserted it is connected to a bottle which contains water. The fluid or air then travels down the tube, into the bottle with the water acting as a seal preventing air or fluid coming back up the tube into the chest.

Insertion:

The procedure is performed using an aseptic technique to minimize the risk of infection. The skin of the patient has to be cleaned with an alcohol cleaner to kill any bacteria and a local anesthetic is then injected to numb the area where the tube is to be inserted, this can ‘sting’ temporarily but resolves quickly. A small cut is then made in the anaesthetized area and the doctor gently opens up a path for the chest drain. It is normal to feel a sensation of pressure and tugging as the drain is gently eased into the chest.

The chest drain is held in place with stitches and the exit site is covered with gauze and a waterproof dressing. The end of the tubing is connected to a drainage bottle which acts as the underwater seal and collection chamber. The chest drain will be monitored regularly.

Suction:

Occasionally a lung needs some help to re-expand. If so the drainage bottle can be connected to a suction unit on the wall using a long piece of tubing. The gentle suction provided will help the lung re-expand.

Does and Don’ts of Chest Drains:

As the fluid or air around the lung drains the patient should be able to move more easily.

There are a few simple rules that can follow to minimize any problems:

• Carry the drainage bottle below the level of waist. If it is lifted above to the waist level fluid from the bottle may flow back into the pleural space

• If the drainage is on suction to encourage lung re-expansion it will be necessary to remain close to the bed as the suction tube will limit the movement of the patient

• If disconnection occurs reconnect and ask patient to cough

• If persistent air leak consider low pressure suction

• Whilst in bed keep the drainage bottle on the floor

• Do not pull on the chest drain or tangle

• Do not swing the bottle by the tube

• Observe for post-expansion pulmonary oedema

Removal:

The chest drain will stay in between one day to many days depending on how well the patient respond to the treatment during which several chest x-rays have been taken.

Removing the drain is a simple procedure. Once all the dressings are removed the drain is gently pulled out. The doctor or nurse may ask the patient for breathing in a particular way while the drain is removed. This can feel a little uncomfortable but only lasts a few seconds.

After drain removal procedure is over, a stitch is often left where the drain has been which will be removed after five to seven days.

Risks:

In most cases the insertion of a chest drain is a routine and safe procedure and most people find breathing is much easier once the chest drain is in place. However, like all medical procedures, chest drains can cause some problems.

Following are The Common Features of a Typical Chest Drainage Catheter:

• Chest Drainage Catheter is used for post operative drainage after cardio thoracic surgery.

• Manufactured from non toxic, medical grade PVC compound.

• Smooth and round open distal end.

• It is provided with large smooth eyes for maximum drainage.

• It is marked at every 2 cm from the last eye to ascertain the depth of placement.

• Proximal end of the catheter is fitted with Taper tongue connecter to provide better forceps grip and smooth penetration

• Available in right angle.

• Sterile, individually packed in peelable pouch pack

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