In this section
Note: This guideline is currently under review.
Drainage of fluid, or evacuation of air, from the pericardial and pleural spaces after cardiothoracic surgery is necessary to prevent effusions, tamponade or pneumothoraces and to also detect hemorrhage. Therefore negative pressure drains are placed in the mediastinum and pleural cavities. The type of drain inserted are closed systems and include: the Atriumᵀᴹ underwater sealed drain (UWSD) (Atrium Ocean, Atrium Medical, Hudson, USA), the Redon Redivacᵀᴹ drain (PFM Redon system, Mepro, Koln Germany), the Jackson-Prattᵀᴹ drain (Cardinal Health, Waukegan, Illinois) and/or the ConvaTec Minivacᵀᴹ drain (ConvaTec, NewZealand)
NB: Passive drainage systems with an attached collection bag (such as a urine or bile bag) are not used following cardiothoracic surgery.
To provide a description of the types of drains available and to describe the safe and competent nursing management of Redivacᵀᴹ and Jackson-Prattᵀᴹ drains in the post-operative cardiac surgical patient. Management of UWSD can be found in the following link:
http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_Drain_Management/ Definition of terms
The following terms are defined in the
Chest Drain Management Clinical Guideline
Children with multiple drains following cardiac surgery will have each drain labelled appropriately, for example a child with 3 drains will have on the tubing or drain itself if the insertion is in the “left pleural”, “right pleural” or “mediastinal” space.
This drainage system maintains low negative pressure without the need for wall suction. The concertina drain is squeezed to create suction
Minivac drains maybe inserted in the superficial mediastinum in neonates or following delayed sternal closure to minimise risk of infection. The decision for the drain to be redivac or minivac in the mediastinum is as per surgeon’s preference.
Figure 4. ConvaTec Minivacᵀᴹ Drain
The patient group will have undergone cardiac or thoracic surgery and will have had a median sternotomy or thoracotomy wound incision. Patients attending cardiac preadmission clinic will receive the following resource informing parents of the post-operative course, including chest drain management, ward staff should check such information has been received:
Changing the redivac chamber
Taking a sample from a Jackson-Pratt Drain
Loss of high vacuum suction on redivac drain
Converting a redivac to an underwater seal drain (UWSD):
Refer to the following guideline:
Pleural and Mediastinal Drain Management after Cardiothoracic Surgery
Please remember to read the
The development of this nursing guideline was coordinated by Annabelle Santos, CSN, Koala, and approved by the Nursing Clinical Effectiveness Committee. Updated December 2017.