How does a nurse provide care for a patient with a chest drain?

From the Guidelines

Caring for a patient with a chest drain requires careful monitoring and specific interventions to ensure proper functioning and prevent complications, with the nurse regularly assessing the chest drainage system and maintaining the prescribed suction level, as recommended by the BTS guidelines for the management of pleural infection in children 1. The nurse should regularly assess the chest drainage system, checking for fluctuation in the water seal chamber during respiration, maintaining the prescribed suction level (typically -10 to -20 cm H2O), and ensuring the collection chamber is below chest level to prevent fluid backflow. The drainage should be monitored for amount, color, and consistency every 1-2 hours initially, then every 4 hours once stable, documenting output accurately, and the nurse must maintain the integrity of the closed system, avoiding kinks or dependent loops in tubing, and never clamping the tube unless specifically ordered, as stated in the guidelines for chest drain management 1. Dressing changes around the insertion site should be performed using aseptic technique every 24-48 hours or when soiled, assessing for signs of infection, subcutaneous emphysema, or air leaks, and the use of a “purse string” suture is controversial, but the drain must be well secured after insertion to prevent it falling out, as described in the BTS guidelines for the management of pleural infection in children 1. Pain management is essential, typically with scheduled analgesics like morphine 2-4mg IV every 4 hours or oral alternatives, and patient positioning should be optimized, usually with the head of bed elevated 30-45 degrees and positioning on the affected side as tolerated, as recommended by the guidelines for chest drain management 1. The nurse should monitor vital signs every 4 hours, watching for signs of respiratory distress, and teach the patient to perform deep breathing exercises hourly while awake, and the indications for suction are unclear, but it is commonly believed that it improves drainage, and if suction is used, this should be done via the underwater seal at a pressure of 5–10 cm H2O, as stated in the guidelines for the management of pleural infection in children 1. Some key points to consider when caring for a patient with a chest drain include:

• Regularly assessing the chest drainage system and maintaining the prescribed suction level
• Monitoring the drainage for amount, color, and consistency
• Maintaining the integrity of the closed system and avoiding kinks or dependent loops in tubing
• Performing dressing changes around the insertion site using aseptic technique
• Optimizing patient positioning and providing pain management
• Monitoring vital signs and teaching the patient to perform deep breathing exercises, as recommended by the BTS guidelines for the management of pleural infection in children 1.

From the Research

Nursing Care for Patients with Chest Drains

The nursing care for patients with chest drains involves several key aspects, including:

• Monitoring vital signs 2
• Pain management 2, 3
• Proper positioning of the system 2
• Filling the collection bottle with distilled water or saline solution, leaving the distal end of the stem submerged 1.5 to 2.5 centimeters 2

Precautions and Nursing Tasks

Nurses should be aware of the following precautions and tasks:

• 60 nursing tasks were mapped, 13 of which were carried out prior to inserting the drain, nine during insertion and 38 after insertion of the chest drain 2
• Differences in the indication for clamping the system and milking the drain/drainage system were found 2
• Nursing management of patients with chest drains includes aspects such as pain management and mechanism of breathing 3

Chest Drain Management

Chest drain management involves:

• Understanding the principles of intrapleural drainage 4
• Knowing the indications for chest drain insertion, related signs and symptoms, and potential complications 4
• Providing a detailed analysis of the nursing care of a patient with a chest drain 5
• Examining the nursing role in chest drain management from insertion to removal 3