Background
Monitoring and removal of chest drains in patient who are being cared for in the CDU at CUH.
- Observation Record (to be filled in by nursing staff) here
- Please encourage early use of the CDU exercise bike
- Please record (sheet) if the drain is swinging, bubbling, suction details, drain details, physio
Chest drain issues - troubleshooting
Drain is not oscillating:
- CXR first
- If lung is down - can flush drain to ensure patency
- If lung has up - see indications for removal of chest drain
Tube becomes disconnected:
- Reconnect tube
- CXR post reconnection
Tube becomes dislodged:
- CXR – if persistent pneumothorax can reinsert
- If no PTX – no need to reinsert drain
Arrhythmia (Tube adjoining cardiac area):
- Withdraw the chest drain
Chest drain removal checklist
- Fluid drainage < 200mls/ 24 hours
- No air leak (bubbling) on Valsalva/Cough
- CXR resolution – full (>90%) expansion
- Do not clamp drain
- Proceduralist & assistant available for procedure
- CXR 4 hours post removal
Procedure for drain removal
- Give analgesia both systemic and local 5 mls 1% Lignocaine infiltrate
- Remove the external dressings, cut the stitches that secure the tube while tube is still supported
- A 2 person technique;
- Nurse/ doctor to stabilize and remove drain
- The second (Doctor/ ANP) sutures
- Ask the patient to hold breath in either inspiration or slow expiration
- Gently remove the chest drain, tighten & secure the vertical mattress suture
- Once drain is removed, tighten the one remaining suture and place an occlusive dressing
Post-procedure care
- Referral to smoking cessation service
- Book repeated CXR (note date please)
- Patient information on post PTX