Trouble Shooting and Pitfalls
The following are some hints and tips to avoid the common problems associated with chest drains and to know what actions to take when problems do occur;
- Drain not bubbling or swinging- could be either blocked, clamped or have inadvertently fallen out-check patient, drain, connections, tubing, GET SENIOR HELP
- Tubing becomes disconnected - clamp drain and replace tubing
- Leakage from drain site - check wound, send swab
- Drain bubbling ++- could be either leak from chest drain connections or persistent air leak within the lung, check patient, drain, connections, tubing, GET SENIOR HELP
- Sudden increased blood or fluid losses in drain - GET SENIOR HELP as patient may need surgery(>1500ml stat of blood or 200ml/hour indicates need for thoracotomy)
Best Practice Statement
Never milk or strip chest drains
Rationale: This can lead to underlying damage to the lung
Source of Evidence: Marsden
Never clamp a chest drain unless changing the bottle or the tubing has become disconnected (using thumb and forefinger rather than clamp avoids inadvertently leaving it on), or unless under direct supervision of a senior respiratory physician in an appropriate specialised clinical environment. An exception is that when draining a large effusion, the drain may be clamped for one hour after 1.5 L has drained to minimise risks of flash re-expansion pulmonary oedema.
Drainage bottles and tubing should be replaced every 48-72 hours or when volume of drainage in the bottle exceeds 500-600 mls.
In some specialised environments such as respiratory wards it may be necessary to apply suction to a drain, if for example a pneumothorax is failing to respond. Again this should be ordered and supervised by a respiratory physician. High volume, low pressure suction must be used, not standard wall suction as they are high pressure.
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