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Chest Drains

Chest Drains. By Michael Shackcloth. Function. Conduit to remove fluid or air from the pleural or pericardial spaces The fluid may be blood, pus or pleural effusion Allow the lungs and heart to work unrestricted. Compartments of the chest. Spaces That Need Draining Following Heart Surgery.

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Chest Drains

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  1. Chest Drains By Michael Shackcloth

  2. Function • Conduit to remove fluid or air from the pleural or pericardial spaces • The fluid may be blood, pus or pleural effusion • Allow the lungs and heart to work unrestricted

  3. Compartments of the chest

  4. Spaces That Need Draining Following Heart Surgery • ANY SPACE THAT HAS BEEN OPENED IS A POTENTIAL SITE WHERE BLOOD MAY COLLECT • Valve surgery - Pericardium • Bypass graft surgery – Pericardium • Left pleural space if opened during LIMA harvest • Right pleural space if opened during RIMA harvest • Right pleural space often opened during OPCAB to allow heart to move across making grafting easier

  5. Spaces That Need Draining Following Thoracic Surgery • Only a single pleural cavity opened • Air and blood may collect in the space • Two drains • Apical drain – Air • Basal drain – Blood • Traditionally apical drain is placed anteriorly and basal drain at the back

  6. Physiology of Chest Drains

  7. Mechanism of Action • Fluid or air passes from an area of high pressure to one of a lower pressure • An underwater seal is therefore needed to stop air being sucked into the chest via the drain

  8. Mechanism of Action • Drainage occurs when pleural pressure is positive (unless suction is applied) • Fluid within the pleural cavity drains into the water seal • Air bubbles through the water seal into the outside world • Length of tubing below the fluid level is important. The longer the length the greater the resistance to drainage

  9. Chest Drain

  10. Suction • What does it do? • Makes the external pressure negative • Air or blood drains more easily out of chest Dangers • If on to high tissues may get sucked into the drain damaging them • If connected but not on similar effect to clamping the drains

  11. Does and Don’ts of Chest Drains • Do not clamp a functioning drain as this can lead to a tamponade ortension pneumothorax • If becomes disconnected, reconnect and ask patient to cough • Always keep drain below level of patient • If raised above patient the contents may siphon back into the chest

  12. Drain Removal • Explain to patient what you are going to do and what they have to do • Get everything ready • Check suture is in place to close drain hole • Get patient to practice what is expected of them.

  13. Timing of Drain Removal • Remember air moves from higher pressures to lowest pressure • Pleural pressure always lower than atmospheric pressure so air will move into the pleural space from outside

  14. On Expiration • Pleural pressures at their highest • But still less than atmospheric pressure • Difficult to hold breath at full expiration • Natural reaction to pain is to take a deep breath in

  15. On Inspiration • Easy to hold breath on maximal inspiration • Pleural pressure most negative therefore air more likely to move into pleural space

  16. Valsalva Manoeuvre • Forced expiration against a closed glottis • Creates a positive intrapleural pressure • Easy for patient to hold

  17. Any Questions ?

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