In this section
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) is 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:
The following terms are defined in the
Chest Drain Management Clinical Guideline
The type and location of drain insertion should be clearly identified in the LDA section of the patients EMR.Children with multiple drains following cardiac surgery will have each drain labelled appropriately in terms of the location of drain insertion, i.e either “left pleural”, “right pleural” or “mediastinal” space.
This is considered a conventional drainage system that is attached to low-pressure wall suction to maintain a negative pressure between -5cm H2O and -20cmH2O (1.96kPa); unless stated otherwise suction should be applied at all times (see chest drain management CPG).
The tubing is soft silicone, however semi-rigid tubing can be attached to the silicone tubing and inserted into the patient. The drainage system allows collection of fluid up to 2L.
UWSD is preferred if a significant drop in mean arterial pressure is a concern which can occur after surgery of single ventricle anomalies.
Pigtail tubing maybe attached to an UWSD if pneumothorax or pleural effusion develops after cardiac surgery.
These drainage systems are preferred in situations where there may be an ongoing air leak (eg: open chest/delayed sternal closure) or when accurate measurement of losses are required or large volumes of drainage are expected.
Figure 1. Atriumᵀᴹ Underwater Seal Drain (UWSD)
Figure 3. Jackson-Prattᵀᴹ Drain
Figure 4. 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 Cardiac Surgery Information Guide For parents, carers and families which provides information of the post-operative course, including chest drain management; ward staff should check such information has been received.
Vacuum on the Redivac system
Vacuum on the Jackson-Pratt system
Loss of high vacuum suction on redivac drain
Converting a redivac to an underwater seal drain (UWSD):
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 October 2021.