Appropriate chest drain management is required to maintain respiratory function and haemodynamic stability. To describe safe and competent management of UWSD chest drains by the health care team. Tension Pneumothorax : One way valve effect which allows air to enter the pleural space, but not leave.
Air builds up and forces a mediastinal shift. Ventilated patients are particularly high risk due to the positive pressure forcing more air into the pleural space. Tension pneumothorax can result in rapid clinical deterioration and is an emergency situation.
UWSD are designed to allow air or fluid to be removed from the pleural cavity, while also preventing backflow of air or fluid into the pleural space. Flutter valve e. Pneumostat, Heimlich valve : One way valve system that is small and portable for transport or ambulant patients. Allows air or fluid to drain, but not to backflow into pleural cavity.
Chest drains should not be clamped unless ordered by medical staff. There is a risk of the patient developing a tension pneumothorax if a drain is clamped while an air leak is present. Assessment of chest tube and system tubing should occur at the beginning of the shift and every hour throughout the shift. Collect drainage specimens for culture through the needless sampling port located by the in line connector.
Please remember to read the disclaimer. Updated February The Royal Children's Hospital Melbourne. Chest drain management. Chest drain management Note: This guideline is currently under review.
Introduction Aim Definition of Terms Indications for Insertion Insertion Set Up Management Removal of chest drain Complications and Troubleshooting Family Centred Care Companion Documents References Evidence Table Introduction Chest drains also known as under water sealed drains UWSD are inserted to allow draining of the pleural spaces of air, blood or fluid, allowing expansion of the lungs and restoration of negative pressure in the thoracic cavity.
Definition of terms Chylothorax : Collection of lymph fluid in the pleural space Haemothorax : Collection of blood in the pleural space Pneumothorax : Collection of air in the pleural space Tension Pneumothorax : One way valve effect which allows air to enter the pleural space, but not leave. Tension pneumothorax can result in rapid clinical deterioration and is an emergency situation Pleural effusion : Exudate or transudate in the pleural space Under Water Seal Drain UWSD : Drainage system of 3 chambers consisting of a water seal, suction control and drainage collection chamber.
The tube may be connected to a machine to help with the drainage. The tube will stay in place until the fluid, blood, or air is drained from your chest. Inserting a chest tube may also help your doctor diagnose other conditions, such as lung damage or internal injuries after a trauma.
This is done to help confirm whether fluid or air buildup is causing the problem and to determine if a chest tube is needed.
Some other tests may also be done to evaluate pleural fluid, such as a chest ultrasound or chest CT scan. Someone who specializes in lung conditions and diseases is called a pulmonary specialist. A surgeon or pulmonary specialist will usually perform the chest tube insertion. During chest tube insertion, the following happens:. Preparation: Your doctor will prepare a large area on the side of your chest, from your armpit down to your abdomen and across to your nipple.
Preparation involves sterilizing the area and shaving any hair from the insertion site, if necessary. Your doctor may use an ultrasound to identify a good location for inserting the tube. Anesthesia: The doctor may inject an anesthetic into your skin or vein to numb the area. The medication will help make you more comfortable during the chest tube insertion, which can be painful.
Where they make the incision depends on the reason for the chest tube. Insertion: Your doctor will then gently open a space into your chest cavity and guide the tube into your chest. Chest tubes come in various sizes for different conditions. Your doctor will stitch the chest tube in place to prevent it from moving. A sterile bandage will be applied over the insertion site. Drainage: The tube is then attached to a special one-way drainage system that allows air or fluid to flow out only.
This prevents the fluid or air from flowing back into the chest cavity. A doctor or nurse will monitor your breathing and check for possible air leaks. How long the chest tube is left in depends on the condition that caused the buildup of air or fluid. Some lung cancers can cause fluid to reaccumulate. Doctors may leave the tubes in for a longer period of time in these cases.
This is known as a spontaneous pneumothorax. Below, you can watch a short video from one of our doctors explaining more about chest drains. The chest tube usually stays in for a few days — during this time, you will remain in the hospital. Sometimes your drain will be attached to suction on the wall which may limit your movement away from your bed. When your doctor is sure that no more fluid or air needs to be drained, the chest tube will be removed.
Removing the drain can cause some brief discomfort, and you will be given pain relief before the tube is removed. Your doctor will remove the stitch holding the tube in place and ask you slowly breathe in and out for a few breaths. You will need to hold your breath while your nurse quickly removes the drain and applies a dressing to seal the cut. After your procedure, you will have an X-ray to make sure that there is no more excess fluid or air in the space surrounding your lungs.
When you return home, you may notice some pain from the cut in your chest. The pain should go away in weeks. You will need to see your doctor a few days after your procedure to remove the dressing.
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