In this section
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 and NICU; or in the emergency department and ward areas in emergency situations.
Some cardiac surgical patients will have Redivac drains inserted, these are different from UWSD. Please refer to redivac guideline http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Pleural_and_mediastinal_drain_management_after_cardiothoracic_surgery/
To describe safe and competent management of (UWSD) chest drains by 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 which allows air to enter the pleural space, but not leave. Air builds up and forces 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 and 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 and 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.
RCH access only: See
Aseptic Technique Policy and Procedure
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.
Dressings should be changed if:
Exact type of dressing may depend on treating medical team
For cardiac surgical patients with drains inserted intraoperatively:
For all other chest drains:
Ensure drain is secure
Procedure (also see figure below)
There must be a written order by medical staff in EMR
Post Procedure Care
Please remember to read the disclaimer
The development of this nursing guideline was coordinated by Daniel Wall and Grace Larson, Rosella PICU, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2016.