CnLS1 1nCkACCS1CM 1U8L

Cverv|ew
1he mechanlcs of venLllaLlon relaLe Lo Lhe negaLlve lnLraLhoraclc pressure LhaL draws alr
lnLo Lhe lungs durlng sponLaneous resplraLlon 1hls negaLlve pressure ls besL malnLalned
ln Lhe pleural space whlch ls Lhe poLenLlal space beLween Lhe parleLal and vlsceral
layers of Lhe pleura CollecLlons of alr fluld or blood ln Lhe pleural space noL only
compress Lhe lung Llssue buL also cause Lhe pleural pressures Lo become poslLlve
causlng lnapproprlaLe venLllaLlon
ChesL dralns are lnserLed Lo remove paLhologlcal collecLlons of alr or fluld ln Lhe pleural
space Lo allow Lhe recreaLlon of Lhe essenLlal negaLlve pressures ln Lhe chesL and Lo
permlL compleLe expanslon of Lhe lung Lhereby resLorlng normal venLllaLlon ChesL
dralns are very slmple and effecLlve Lools ln Lhe managemenL of Lhoraclc and pleural
paLhology 1hey need proper safe lnserLlon and correcL managemenL ChesL dralns are
llfesavlng ln crlLlcal care
ChesL dralnage sysLems work by comblnlng Lhe followlng 3 efforLs
O xplraLory poslLlve pressure from Lhe paLlenL helps push alr and fluld ouL of Lhe chesL
(eg cough valsalva maneuver)
O ravlLy helps fluld dralnage as long as Lhe chesL dralnage sysLem ls placed below Lhe
level of Lhe paLlenL's chesL
O ucLlon can lmprove Lhe speed aL whlch alr and fluld are pulled from Lhe chesL
Any caLheLer lnserLed Lhrough Lhe chesL wall Lo remove alr or fluld from Lhe pleural
space may be called a chesL Lube or chesL draln Crosswell PewlLL ls credlLed as belng
Lhe flrsL Lo use a chesL draln ln 1876 when he used a red rubber caLheLer Lo draln an
empyema Lhoracls
1
ldeally Lhe chesL Lubes (also called tbotoclc cotbetets) musL be
nonLoxlc nonLhrombogenlc and sofL buL wlLh Lhlck reslllenL walls 1he LradlLlonal red
rubber Lubes have mosL of Lhese feaLures buL belng opaque Lend Lo be qulckly
occluded by encrusLaLlon and flbrlnous secreLlons
1oday chesL Lubes are made of clear plasLlc (vlnyl or sllasLlc) 1hey are avallable ln
varylng dlameLers slzed ln mulLlples of 4 on Lhe lrench scale (eg 12l 16l 20l up Lo
36l) 1hey have mulLlple slde holes Lo allow effecLlve dralnage and have lengLh markers
Lo help noLe Lhe dlsLance of Lhe lowesL hole from Lhe skln surface A radlopaque sLrlp
llnes Lhe Lube Lo help easy vlsuallzaLlon on chesL radlography
2
ome Lubes are
mounLed on sLyleLs or Lrocars LhaL acL as guldes Lo help lnserLlon and proper placemenL
of Lubes lmproper managemenL of lnserLed chesL Lubes resulLs ln premaLure removal or
delayed removal boLh of whlch lead Lo lncreased hosplLal sLay and cosLs
When carlng for and malnLalnlng a paLlenL wlLh a chesL Lube Lhe followlng sLeps are
lmporLanL keep chesL Lubes paLenL noLe Lhe presence of dralnage and flucLuaLlons and
observe Lhe paLlenLs vlLal slgns and levels of comforL 1he chesL dresslng sLaLus and
Lype of sucLlon musL be noLed
|cat|o
lndlcaLlons for chesL dralns lnclude Lhe followlng
O 9neumoLhorax (sponLaneous Lenslon laLrogenlc LraumaLlc)
O 9leural collecLlon
4 9us (empyema)
4 lood (hemoLhorax)
4 Chyle (chyloLhorax)
4 ,allgnanL effuslons (pleurodesls)
O 9osLoperaLlve
4 1horacoLomy
4 vldeoasslsLed Lhoraclc surgery (vA1)

Cotra||cat|o
When a chesL draln ls needed for any of Lhe lndlcaLlons llsLed above no absoluLe
conLralndlcaLlons exlsL for chesL draln lnserLlon
Aethe|a
O lollowlng chesL Lube placemenL anesLhesla ls noL requlred durlng Lhe managemenL
phase
O lor more lnformaLlon on chesL Lube placemenL see 1ube 1horacosLomy
3

O AL Lhe Llme of Lube removal 3 mL of 1 lldocalne hydrochlorlde ls lnfllLraLed wlLh a 24
gauge needle around Lhe emerglng Lube from Lhe chesL wall

Lqu|pmet
O ChesL dralnage boLLles (see descrlpLlon of dralnage sysLem below)
O AdequaLe lengLh (13 2 m) of sLerlle LransparenL plasLlc Lublng (eg vlnyl/sllasLlc)
O ApproprlaLe sLerlle connecLors
O Adheslve Lape
O Angled clamps (2) for clamplng Lhe Lube when needed
O lsLllled waLer Lo flll ln Lhe dralnage boLLle

ra|age Sytem
1he Lyplcal dralnage sysLem conslsLs of 3 boLLles (1) underwaLer seal boLLle (2) Lrap
boLLle and (3) sucLlon regulaLor boLLle

Uerwater ea| bott|e
An example ls shown below
1he underwaLer dralnage boLLle
1he underwaLer seal boLLle ls Lhe mosL lmporLanL elemenL ln pleural dralnage lL ls
essenLlally an exLenslon of Lhe chesL Lube underwaLer a lowreslsLance oneway valve
for Lhe evacuaLlon of pleural conLenLs
1he underwaLer seal ls a condulL for Lhe expulslon of alr and fluld from Lhe chesL agalnsL
mlnlmal reslsLance When lnLrapleural pressure rlses (eg explraLlon coughlng) alr ls
forced ouL of Lhe lungs Lhrough Lhe mouLh and free conLenLs of Lhe pleural space are
forced ouL Lhrough Lhe chesL Lube and lnLo Lhe underwaLer seal dralnage boLLle
4

1he underwaLer seal ls also an anLlreflux valve 8eenLry of alr lnLo Lhe pleural space
when lnLrapleural pressures become negaLlve (eg lnsplraLlon) ls blocked by Lhe
underwaLer seal WaLer can be drawn up Lhe Lube only Lo Lhe helghL equal Lo Lhe
negaLlve lnLraLhoraclc pressure (usually up Lo 20 cm of waLer) 1herefore Lhe
apparaLus musL be kepL far enough below Lhe paLlenL Lo prevenL waLer from belng
sucked up lnLo Lhe chesL (100 cm ls sufflclenL)
4
1he waLer ln Lhls Lube ls referred Lo as
Lhe column of waLer lL reflecLs Lhe changes ln lnLraLhoraclc pressure wlLh each
lnsplraLlon and explraLlon
1he end of Lhe Lube ln Lhe underwaLer seal boLLle musL remaln covered wlLh waLer aL all
Llmes When a broadbased boLLle (eg 1udordwards) and a narrow Lube are used
elevaLlon of Lhe waLer column ln Lhe Lube lowers Lhe level ln Lhe reservolr by only a very
small amounL keeplng Lhe seal lnLacL
1he end of Lhe Lube musL noL be kepL Loo far below Lhe surface of waLer because Lhe
reslsLance Lo expulslon of alr from Lhe chesL ls equal Lo Lhe lengLh of Lublng LhaL ls
underwaLer keeplng Lhe Llp of Lhe Lube 23 cm below Lhe surface of waLer should be
enough Lo acL as a consLanL valve
3 2

1he whole sysLem ls placed erecL 100 cm below Lhe level of Lhe paLlenL's chesL 1hls
placemenL alds gravlLy dralnage of chesL conLenLs lnLo Lhe boLLle and prevenLs reenLry
of fluld lnLo Lhe chesL durlng Lhe upward swlng of Lhe fluld ln Lhe Lube durlng
lnsplraLlon
6 7

1rap bott|e
An example ls shown below
1he Lrap boLLle
When excesslve fluld dralns from Lhe chesL Lhe level of fluld ln Lhe underwaLer seal ls
ralsed 1hls lncreases reslsLance Lo furLher ouLflow of fluld from Lhe chesL
1o decrease Lhls reslsLance a Lrap boLLle ls lnLroduced beLween Lhe chesL Lube and Lhe
underwaLer seal 1he Lrap boLLle collecLs Lhe fluld dralnlng ouL of Lhe chesL whlle Lhe alr
passes on Lo Lhe second boLLle 1hls keeps Lhe underwaLer seal aL a consLanL level
8

Suct|o regu|ator bott|e
An example ls shown below
1he sucLlon boLLle
ucLlon hasLens Lhe expanslon of Lhe lung AnoLher boLLle ls needed Lo lnLroduce
sucLlon regulaLlon Lo Lhls sysLem
1he sucLlon regulaLor boLLle has a 3hole sLopcock horL Lubes are passed Lhrough 2 of
Lhe holes Cne shorL Lube connecLs Lo Lhe underwaLer seal boLLle's venL Lube and Lhe
oLher shorL Lube connecLs Lo Lhe sucLlon source An aLmospherlc venL runs Lhrough Lhe
3
rd
hole passlng below Lhe level of waLer ln Lhls boLLle
When sucLlon ls applled alr ls drawn down Lhe aLmospherlc venL ln Lhls boLLle equal Lo
Lhe pressure lnslde Lhe boLLle LhaL ls decreased by Lhe vacuum under sLronger vacuum
alrflow Lhrough Lhe aLmospherlc venL commences and alr bubbles Lhrough Lhe waLer ln
Lhe boLLle buL Lhe level of sucLlon ln Lhe boLLle remalns Lhe same
1hls consLanL level of low pressure sucLlon ls now LransmlLLed Lo Lhe underwaLer seal
boLLle and Lhen lnLo Lhe pleural cavlLy Lhus aldlng evacuaLlon of conLenLs Lhere
allowlng a qulcker reexpanslon of Lhe underlylng lung 1he maxlmum force of sucLlon ls
deLermlned by Lhe depLh of Lhe aLmospherlc venL underwaLer ln Lhe sucLlon regulaLlon
boLLle
2

1o obLaln a sucLlon of 20 cm of waLer seL Lhe Llp of Lhe Lube 20 cm below Lhe surface
of Lhe fluld now lncrease Lhe vacuum gradually unLll alr bubbles genLly and consLanLly
Lhrough Lhe aLmospherlc venL ln Lhe waLer durlng boLh phases of resplraLlon A consLanL
pressure of 20 cm of waLer ls now LransmlLLed Lo Lhe underwaLer seal and on Lo Lhe
chesL draln
1he role of sucLlon ls now belng debaLed ome schools of LhoughL say sucLlon delays
Lhe seallng of alr leaks from Lhe underlylng lung
9

Mu|t|fuct|o Chet ra|age Sytem
1he mulLlple boLLles and numerous connecLlons of Lhe Lyplcal 3boLLle sysLem resulL ln a
bulky bedslde devlce whlch can be prone Lo accldenLal dlsconnecLlons and blocks ln Lhe
sysLem ln addlLlon sLerlllLy ls dlfflculL Lo malnLaln ln such a sysLem 1hese sysLems
Lherefore have been largely replaced by commerclally produced dlsposable plasLlc
mulLlfuncLlon unlLs (eg Codman 9leurovac ALrlum) LhaL flL lnLo a slngle box and work
on Lhe same prlnclples as shown below
ChesL draln mulLlpurpose unlL
ChesL draln mulLlpurpose model Casls (ALrlum ,edlcal CorporaLlon Pudson nP)
,ulLlfuncLlon chesL dralnage sysLems have been deslgned prlmarlly for managemenL of
chesL Lubes afLer cardloLhoraclc surgery and chesL Lrauma
,ulLlchamber boLLles are provlded lncorporaLlng boLh funcLlonal and safeLy feaLures
1hey comblne paLlenL proLecLlon wlLh effecLlve dralnage accuraLe fluld loss
measuremenL and clear deLecLlon of alr leaks
1he mulLlfuncLlon sysLems allow slngle or mulLlcaLheLer dralnage and are sulLable for
boLh gravlLyasslsLed and sucLlonasslsLed dralnage 1he unlL has a laLexfree paLlenL
Lube and a fllLered waLer seal Lo prevenL conLamlnaLlon
unlLs wlLh 3 or 4 chambers are also avallable whlch provlde 2 lndependenL collecLlon
chambers an auLomaLlc poslLlve pressure rellef venL and a fllLered negaLlve pressure
valve
10

ach mulLlfuncLlon chesL dralnage sysLem conLalns Lhe followlng
O CollecLlon chamber llulds draln dlrecLly lnLo Lhls chamber whlch ls callbraLed ln mL
O WaLer seal 1hls ls a oneway valve uLube deslgn LhaL can monlLor alr leaks and
changes ln lnLraLhoraclc pressure
O ucLlon conLrol chamber 1hls chamber ls also a uLube Lhe narrow arm ls Lhe
aLmospherlc venL and Lhe large arm ls Lhe fluld reservolr 1he sysLem ls regulaLed and
conLrolllng negaLlve pressure ls easy 1he sucLlon chamber also helps monlLor
lnLraLhoraclc pressure lor gravlLy dralnage wlLhouL sucLlon Lhe level of waLer ln Lhe
waLer seal chamber equals Lhe lnLraLhoraclc pressure
11
lor sucLlonasslsLed dralnage
Lhe level of waLer ln Lhe sucLlon conLrol chamber plus Lhe level of waLer ln Lhe waLer
seal chamber equals Lhe lnLraLhoraclc pressure
11


9o|t|o|g
O mergenL and elecLlve chesL dralns are usually placed ln Lhe Lrlangle of safeLy (shown
below) an area dellneaLed by Lhe anLerlor border of laLlsslmus dorsl Lhe laLeral border
of pecLoralls ma[or and a horlzonLal llne laLeral aL Lhe level of Lhe nlpple or abouL Lhe
3Lh lnLercosLal space 1hls corresponds Lo an lnserLlon area beLween Lhe mldaxlllary and
anLerlor axlllary llnes aL Lhe level of Lhe nlpple ee e,edlclne Loplc 1ube
1horacosLomy for a deLalled descrlpLlon of chesL Lube lnserLlon
1he Lrlangle of safeLy
O ,a[or obLruslve dresslngs around Lhe chesL Lube are unnecessary and poLenLlally
dangerous 1hey can glve rlse Lo klnklng of Lhe Lube Lherefore renderlng Lhe Lube
useless and poLenLlally allowlng Lhe accumulaLlon of alr and Lhe formaLlon of a Lenslon
pneumoLhorax
O 1he correcL Laplng of Lhe emerglng chesL Lube from Lhe paLlenL ls wlLh a mesenLry fold
of adheslve Lape LhaL holds Lhe Lube Lo Lhe Lrunk of Lhe paLlenL 1hls allows some slde
Loslde movemenL of Lhe Lube prevenLs klnklng of Lhe Lube as lL passes Lhrough Lhe
chesL wall and ls far less palnful Lo Lhe paLlenL Lhan Laplng Lhe Lube dlrecLly Lo Lhe chesL
wall
Mu|t|fuct|o chet ra|age ytem etup
O lollow Lhe manufacLurer's lnsLrucLlons for addlng waLer Lo Lhe chambers 1hls ls usually
2 cm ln Lhe waLer seal chamber and 20 cm ln Lhe sucLlon conLrol chamber
O ConnecL Lhe 6fL paLlenL Lube Lo Lhe Lhoraclc caLheLer
O ConnecL Lhe draln Lo vacuum
O lowly lncrease vacuum unLll genLle bubbllng appears ln Lhe sucLlon conLrol chamber
O e sure noL Lo allow Loo much bubbllng ln Lhe sucLlon conLrol chamber xcesslve
bubbllng ls noL needed cllnlcally ln 98 of paLlenLs vlgorous bubbllng ls loud and
dlsLurblng Lo mosL paLlenLs vlgorous bubbllng also causes rapld evaporaLlon ln Lhe
chamber whlch lowers Lhe level of sucLlon

1ech|que
Aa|ge|a
ChesL dralns are palnful for Lhe paLlenL AdequaLe analgesla (orally recLally or
parenLerally) helps Lhe paLlenL cooperaLe beLLer for Lhe chesL exerclses and
physloLherapy
9aLlenLs whose chesL Lubes were lnserLed posLoperaLlvely or who have assoclaLed rlb
fracLures need sLronger forms of analgesla such as paLlenLconLrolled anesLhesla (9CA)
wlLh dlluLed oplolds or even an epldural caLheLer for dlrecL dellvery of Lhe analgeslc
medlcaLlon
8reath|g exerc|e a chet phy|otherapy
reaLhlng exerclses and chesL physloLherapy are Lhe malnsLays for Lhe qulck expanslon
of Lhe lung
lncenLlve splromeLry (eg 1rlllo lncenLlve splromeLer) glves Lhe paLlenL Lhe lmpeLus Lo
expand Lhe lung qulckly
upper llmb movemenLs especlally aL Lhe shoulder help resLore Lhe movemenLs of Lhe
chesL wall
Leam lnhalaLlons and nebullzed bronchodllaLors also encourage qulck lung expanslon
Nur|g maagemet
keep Lhe paLlenL ln a proppedup poslLlon (le 4390) 1he seml llowers poslLlon ls
useful Lo evacuaLe alr (pneumoLhorax)
12
1he hlgh llowers poslLlon ls useful Lo draln
fluld (hemoLhorax) Ad[usL Lublng Lo hang ln a sLralghL llne from Lhe chesL Lube Lo Lhe
dralnage chamber avoldlng excess lengLh and loops
Check LhaL all connecLlons are secure All [olnLs musL be wellLaped wlLh adheslve A
slngle layer of Lape across Lhe long axls of each [olnL holds beLLer Lhan layers of clrcular
Lape over Lhe [olnL 1hls prevenLs dlsconnecLlon and Lhe subsequenL loss of Lhe negaLlve
pressure
Always ensure Lhe correcL poslLlon of Lhe underwaLer seal boLLle 1he boLLle should be
erecL and aL leasL 100 cm below Lhe level of Lhe paLlenL's chesL 1he Llp of Lhe glass Lube
LhaL connecLs Lo Lhe chesL draln should be aL leasL 2 cm below Lhe fluld level ln Lhe
boLLle (and noL more Lhan 7 cm below Lhe fluld level)
ln addlLlon Lo vlLal slgns Lhe followlng lLems need Lo be monlLored every 4 hours
O wlnglng or osclllaLlon of Lhe column of waLer ln Lhe glass Lube connecLed Lo Lhe chesL
draln
O lowlng or alr bubbllng ln dralnage boLLle wlLh quleL resplraLlon and on coughlng
(ubbllng of alr lndlcaLes LhaL Lhe lung ls sLlll leaklng alr 1he cessaLlon of bubbllng
durlng boLh quleL resplraLlon and coughlng lndlcaLes LhaL Lhe alr leak ln Lhe lung has
closed)
O 1ype and quanLlLy of dralnage (lnform pracLlLloner lf dralnage ls 100 mL/h or lf frank
blood)
never llfL Lhe dralnage boLLle above Lhe level of Lhe paLlenL's chesL as fluld from Lhe
boLLle may slphon off lnLo Lhe paLlenL's chesL
keep 2 clamps (angled) aL Lhe bed slde
o noL clamp a bubbllng chesL draln
13
All nurslng procedures paLlenL movemenL and
physloLherapy are permlLLed wlLhouL clamplng Lhe draln Clamp Lubes only for
procedures relaLed Lo Lhe Lube or boLLle (eg Lo change Lhe Lube or boLLle Lo empLy Lhe
boLLle Lo reconnecL an accldenLal dlsconnecLlon of Lhe Lube aL any of Lhe [olnLs)
Avold klnks ln Lhe Lubes 1each Lhe paLlenL Lo look for klnks and Lo avold slLLlng or lylng
on Lhe Lubes
,llk Lhe Lubes frequenLly Lo avold blockage by flbrln plugs or cloLs
Change Lhe connecLlng Lube and boLLle aL leasL once every 48 hours and replace Lhem
wlLh sLerlle equlvalenLs Wash and dlslnfecL equlpmenL Lo remove all resldue before
sLerlllzaLlon
ConnecLlon of 2 emerglng chesL Lubes Lo a slngle dralnage unlL should be done Lhrough
a ?shaped connecLor (noL a 1shaped connecLor whlch causes klnks ln Lhe Lubes) Also
equallzlng Lhe lengLh of Lhe emergenL Lubes before Lhe ? connecLor ls lmporLanL 1hls
avolds klnklng of unequal lengLhs of Lube
2

Suct|o
When sucLlon ls needed lL should be a consLanL lowpressure sucLlon Lo fully remove
Lhe pleural conLenLs wlLhouL causlng paln Lo Lhe paLlenL
1he recommended level of sucLlon ls 3 Lo 20 cm of waLer (1he measuremenL of 20 cm
of waLer ls based on convenLlon noL research)
Plgher negaLlve pressure can lncrease Lhe flow raLe ouL of Lhe chesL buL lL can also
damage Llssue
ucLlon can lmprove Lhe speed aL whlch alr and fluld are pulled from Lhe chesL
Powever recenL research has shown LhaL sucLlon may acLually prolong alr leaks from
Lhe lung by pulllng alr Lhrough an openlng LhaL would oLherwlse close on lLs own
9

ka|ography
erlal chesL radlographs are needed Lo monlLor and conflrm Lhe expanslon of Lhe lung
At|b|ot|c
AnLlbloLlcs are noL needed durlng Lhe presence of a chesL draln for a slmple
pneumoLhorax or hydroLhorax
1he anLlbloLlc cephalexln can be used Lo prevenL Lhe developmenL of an empyema
when a chesL draln has been used ln Lhoraclc Lrauma
1ube remova|
1hls musL be lndlvlduallzed Lo Lhe paLlenL Laklng lnLo conslderaLlon Lhe reason for Lhe
chesL Lube placemenL wheLher or noL Lhe paLlenL has had a pulmonary resecLlon and
wheLher Lhe paLlenL ls mechanlcally venLllaLed
1he Llmlng of Lube removal depends on cllnlcal and radlologlcal evldence of compleLe
expulslon of all conLenLs of Lhe pleural cavlLy wlLh compleLe expanslon of Lhe lung
,lnlmal dralnage should have occurred over Lhe prevlous 24 h When Lhe paLlenL
coughs or performs Lhe valsalva maneuver no alr leak should ensue 1he chesL
radlograph should conflrm compleLe expanslon of Lhe lung
1he swlng ln Lhe fluld level ln Lhe Lube ln Lhe underwaLer seal boLLle should be mlnlmal
relaLlng Lo Lhe normal negaLlve pressures ln Lhe chesL durlng Lhe phases of resplraLlon
enerally for pneumoLhorax a Lrlal perlod of Lube clamplng for 6 hours ls done A
repeaL chesL radlograph ls Lhen Laken lf Lhls shows compleLe expanslon of Lhe lung lL
conflrms LhaL Lhe lung leak has sealed and LhaL a proper adheslon beLween Lhe layers of
Lhe pleura has occurred 1he Lube may be safely removed aL LhaL Llme
1ube LhoracosLomy removal ls a sLerlle procedure LhaL requlres a pracLlLloner and an
asslsLanL efore removal glve Lhe paLlenL a bolus dose of analgesla lnfllLraLlng 3 mL of
1 lldocalne hydrochlorlde wlLh a 24gauge needle around Lhe emerglng chesL draln can
lncrease paLlenL comforL
CuL loose Lhe securlng sLlLch whlle Lhe Lube ls belng supporLed lree Lhe maLLress
(seallng) sLlLch LhaL was lnserLed and kepL long aL Lhe Llme of Lube lnserLlon lf Lhls sLlLch
ls noL ln poslLlon place a verLlcal maLLress sLlLch wlLh sLrong suLure maLerlal (nW 3397
of Lhlcon) across Lhe cenLer of Lhe lnclslon
Pold Lhe ends of Lhe maLLress suLure ready Lo Lle a knoL lnsLrucL Lhe paLlenL Lo cease
resplraLlon ln elLher explraLlon or lnsplraLlon (lncldence of pneumoLhorax afLer Lube
removal ls noL dlfferenL)
14
enLly ease ouL Lhe Lube whlle slmulLaneously Lylng Lhe
knoL Lo close Lhe Lrack
Apply a sofL dresslng lf Lhe sLlLch breaks or cuLs Lhrough slmply compress Lhe obllque
Lrack and apply an occluslve dresslng
10

A chesL radlograph ls repeaLed 4 hours afLer Lhe removal of Lhe Lube LhoracosLomy 1he
resulLs of Lhls radlograph should conflrm LhaL no alr has enLered Lhe chesL and LhaL Lhe
lung conLlnues Lo remaln fully expanded
Comp||cat|o
1roub|ehoot|g chet ra| maagemet
O Column ls noL osclllaLlng lf Lhe column of fluld ln Lhe Lube LhaL connecLs Lhe chesL draln
Lo below Lhe waLer level ln Lhe dralnage boLLle ls noL osclllaLlng Lhe Lube has been
blocked All efforLs musL be made Lo resLore paLency of Lhe Lube by squeezlng mllklng
and even flushlng Lhe dralnage Lublng 8esLoraLlon of paLency ls conflrmed by a
resplraLlonrelaLed swlng ln Lhe dralnlng Lube
O 1ubes goL dlsconnecLed 1hls ls no greaL dlsasLer 8econnecL Lhe Lubes and ask Lhe
paLlenL Lo cough any alr LhaL has enLered Lhe chesL ls forced ouL
O 1ube has been pulled ouL lf Lhe Lube has been pulled ouL lL needs Lo be reposlLloned
uslng all sLerlle precauLlons poslLlon a new Lube lnLo Lhe chesL and secure lL properly
1he new Lube should noL be lnserLed Lhrough Lhe same hole A new LhoracosLomy ls
used and Lhe lnlLlal slLe ls sealed wlLh a verLlcal maLLress suLure
O Leak around Lhe Lube A leak around Lhe Lube lndlcaLes a parLlal block ln Lhe dralnlng
sysLem lf all blocks have been removed and Lhe leak around Lhe Lube perslsLs a slngle
suLure may need Lo be placed along Lhe slde of Lhe Lube Lo narrow Lhe wound and seal
Lhe leak use of Lapes and heavy dresslngs Lo occlude such leaks ls noL useful
O underwaLer seal boLLle broken A broken boLLle has Lo be replaced lmmedlaLely wlLh a
fresh boLLle wlLh a 2hole sLopcock and Lhe underwaLer seal musL be recreaLed 1hen
ask Lhe paLlenL Lo cough Any alr LhaL has enLered Lhe chesL ls forced ouL
Chet ra| comp||cat|o
O locked Lube due Lo poor poslLlonlng omeLlmes Lhe Lube geLs Lrapped ln Lhe ma[or
flssure of Lhe lung lf Lhls occurs Lhe Lube needs Lo be wlLhdrawn and relnserLed
O Cardlac dysrhyLhmla 1he Lube may abuL Lhe medlasLlnum and occaslonally cause
cardlac lrregularlLles llrsL Lry wlLhdrawlng Lhe Lube 23 cm lf Lhls does noL resolve Lhe
problem Lhe Lube may need Lo be relnserLed aL a separaLe locaLlon ,edlcal
managemenL of Lhe arrhyLhmla ls also needed
O 9erslsLenL pneumoLhorax lf a pneumoLhorax perslsLs check for obsLrucLlons or leaks
Clear any obsLrucLlons and seal any leaks ln Lhe dralnage sysLem lf no leak or
obsLrucLlon ls found apply sucLlon of up Lo 20 cm of waLer Lo Lhe dralnage sysLem
O lallure of Lhe lung Lo fully reexpand 1hls ls rarely due Lo blockage of Lhe Lubes and
change of Lubes seldom helps 1he common causes of nonexpanslon of Lhe lung are as
follows
O ronchlal blockage leadlng Lo collapse usually by reLalned spuLum (llberopLlc
bronchoscopy helps clear secreLlons and rule ouL oLher causes of bronchlal obsLrucLlon
eg Lumor)
O 1he presence of a flbrlnous peel (corLex) over Lhe lung (1hls ls Lhe Lhlckened vlsceral
pleura over Lhe collapsed lung Llssue and ls usual ln cases of delayed LreaLmenL of an
empyema A decorLlcaLlon ls Lhe besL way Lo deal wlLh Lhls problem)
O lnfecLlons lnfecLlons occur rarely wlLh chesL dralns buL can range from wound lnfecLlon
Lo empyemas 1hey reflecL breaks ln sLerlllLy and lncorrecL managemenL of Lhe chesL
draln
O 8eexpanslon pulmonary edema 1hls ls also a rare chesL draln compllcaLlon and ls seen
when large effuslons are dralned ln a shorL perlod of Llme lL ls besL prevenLed by
gradual decompresslon