In this section
Note: This guideline is currently under review.
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. The underwater seal also prevents backflow of air or fluid into the pleural cavity. Appropriate chest drain management is required to maintain respiratory function and haemodynamic stability.Chest drains may be placed routinely in theatre, PICU & NNU; or in the emergency department and ward areas in emergency situations.
Some cardiac surgical patients will have Redivac drains in the chest and these are different from UWSD.
To describe safe and competent management of (UWSD) chest drainsby the health care team
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 allowing air to enter the pleural space, but not to leave. Air builds up forcing a mediastinal shift. This leads to decreased venous return to the heart and lung collapse/compression causing acute life-threatening respiratory and cardiovascular compromise. 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
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 & drainage collection chamber. 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.g. pneumostat, Heimlich valve):One way valve system that is small & portable for transport or ambulant patients. Allows air or fluid to drain, but not to backflow into pleural cavity.
See the Chest Drain (Intercostal Catheter) Insertion Clinical Practice Guideline.
Chest drains should not be clamped
Assessment of chest tube and system tubing should occur at the beginning of the shift and every hour throughout the shift
For Theatre Staff involved in the surgical removal of the retained drain tube:
Please remember to read the disclaimer
The development of this clinical guideline was coordinated by Janine Evans, Rosella - PICU. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. First published February 2012, reviewed July 2013