CHEST DRAINAGE

Chest Drainage

Chest Drainage

Introduction

Nurses routinely provide care for patients with chest tubes and chest drainage systems. Chest tubes help to evacuate accumulations of air, fluid (including blood), or combinations of both from the thoracic cavity. Management of the standard 6-foot-long (1.8m-long) drainage tubing that connects the chest tube with the drainage collection device, especially maintaining the tubing free of problematic conditional loops, can be troublesome for nurses. One of the earliest reported research studies of chest tube management is by Playfair, who in 1875 described a plan for continuous chest aspiration to drain empyema. Since then, research has focused primarily on improving the safety and efficacy of the drainage system.

Aslanabadi, Jamshidi, Tubbs & Shoja, 2009

Researchers have studied the level of suction needed to optimize the drainage system, the effects of suction on intrathoracic pressure, and the outcome of milking and stripping the chest drainage tubing. Related research has compared various approaches for gaining access to the thoracic cavity, including traditional thoracostomy, needle aspiration, and videoassisted thoracostomy. Surprisingly, only a single research study addressed the effects of the position of the connection tube on drainage performance. In a laboratory simulation model, pressure and drainage help with the drainage tubing straight, coiled, with a conditional loop, and with a dependent loop that periodically helps to drain the tubing (Fujiki, Shiose & Fukamachi, 2010). After 1 hour, no differences in pressure or drainage are between straight and coiled tubing. However, when the tubing helps to hang in a conditional loop, the pressure in the tubing closest to the lung increased and drainage decreased to zero.

When the conditional loop rises and drained at 15-minute intervals, drainage is no different from drainage with the tube in the straight or coiled positions. Nursing care of patients with chest tube drainage systems has long been based on knowledge that is not research based. Keeping the drainage tubing in a position that avoids the formation of a dependent loop is one of the most frequent recommendations found in nursing texts (Aslanabadi, Jamshidi, Tubbs & Shoja, 2009). Authorities on chest tube management have logically suspected that increased pressure in the tubing impedes drainage and may cause fluid to accumulate in the pleural cavity.

Others modestly suggest that conditional loops impede drainage because of increased pressure.' White and Kenner" concur that higher pleural pressures need to force air or fluid out of the chest when dependent loops were present. Authorities recommend placing chest drainage tubing in either straight or coiled positions to avoid formation of dependent loops .

Fujiki, Shiose & Fukamachi, 2010

Fujiki, Shiose & Fukamachi (2010) suggest that fluid accumulates in the tubing in the coiled position and may eventually decrease the effect of the suction on the system and further recommends that parts of the tubing be lifted to promote the movement of draining fluids into the collection chamber.

In addition, it is critical to control the volume of fluid in the intrapleural space at the beginning of the experiment, a condition that made research on humans ...