Chest Drains

Pradeep Chockalingam

Physiotherapist

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Definition

Chest drain is a process by which air, blood,

pus, or other secretions are removed from the

chest cavity.

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Types

Chest Cavity Drain (Pleural Space)

Pleural Drain / Tape

Pericardial Drain / Tape

Mediastinal Drain

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Chest Cavity Drain

Pneumothorax

Haemothorax

Haemopneumothorax

Pyothorax

Pyopneumothorax

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Causes

R.T.A.

Fracture Ribs

Barotrauma

Infections

Emphysema, Cystic fibrosis

Blunt and Sharp injuries

Accidentally during some medical procedures

over the chest wall

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Types of Pneumothorax

Simple

Open

Tension

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Site of Drain

Meeting point of

mid-axillary line and

the line drawn from

the nipple (4th or 5th

intercostal space)

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Why 4th or 5th IC space ?

During expiration the diaphragm elevates to the level

of 5th rib

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Underwater Seal Chest Drain

It is a simple mechanism by

which using water & gravity

as an one way valve to allow

the air in the pleural cavity to

escape by bubbling and

preventing it from

re-entering into the pleural

cavity.

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Complications

Blocking of tube

Leaking & surgical emphysema, infection

Shallow breathing

Fear of pain & Pain

Stiff Shoulder & Neck

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Points to be consider

Adequate Pain relief.

Check for water column swing, level &

bubbling.

Check for signs of leak, surgical emphysema,

signs of infection.

Do not lift the drain above the chest level.

Do not clamp the drain.

Treat patient as a whole.

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Physiotherapy Tools

PHYSIO

Breathing

ExerciseCoughing Position

Manual

Tech.RoM

Exercise

CPAP

Triflow

Man.Hyp

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Reference

Ciesla ND & Murdock KR (2000): Lines, tubes, catheters, and

physiologic monitoring in the ICU: Car.pul Phy Ther Journal:

Vol11, No 1, page 16-25

Cystic Fibrosis Trust (2002): Clinical Guidelines for the

Physiotherapy Management of Cystic Fibrosis: Cystic Fibrosis

Trust, ISBN: 0-9540536-4-8

Gallon A (1998): Pneumothorax: Nursing Standards: Vol 13, 10,

page 35-39

Laws D et al (2003):BTS guidelines for the insertion of a chest

drain: Thorax: (2003)58(Suppl 2) page:ii53-ii59 & (2005)60

page:152

Senekal M et al (1995): Penetrating stab wounds of the chest

when should chest physiotherapy commence?: A comparative

study: S Afr j surg: Vol 33,No 2, page: 61-66

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Thanks

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