What should be done if the drain rate exceeds 500ml/hr?

Management of High Drain Rate (>500ml/hr)

When drain output exceeds 500ml/hr, immediate intervention is required to prevent complications such as re-expansion pulmonary edema, with the maximum safe drainage rate being 1.5L in the first hour followed by 1L/hr thereafter until drainage is complete. 1

Assessment and Immediate Actions

When faced with a drain rate exceeding 500ml/hr:

1. Slow down the drainage rate immediately

   • Reduce to a maximum of 1.5L in the first hour 1
   • Limit to 1L/hr thereafter 1
   • Consider partial clamping if necessary to control flow

2. Monitor for signs of complications

   • Assess for respiratory distress, decreasing oxygen saturation
   • Monitor vital signs (heart rate, blood pressure, respiratory rate)
   • Watch for signs of re-expansion pulmonary edema
   • Check for peripheral perfusion changes 1

Clinical Evaluation

Perform targeted assessment focusing on:

• Respiratory status: Oxygen saturation, work of breathing, lung sounds
• Hemodynamic stability: Blood pressure, heart rate, signs of shock
• Drain characteristics: Color, consistency (bloody, serous, chylous)
• Imaging: Consider urgent chest X-ray to assess lung expansion and position

Management Algorithm

For Post-Surgical Drains:

1. If drainage is serous/non-bloody:

   • Slow drainage rate to maximum 1.5L first hour, then 1L/hr 1
   • Continue monitoring drain output hourly
   • Consider early drain removal when output decreases to <500ml/day 1, 2

2. If drainage is bloody:

   • Alert surgical team immediately
   • Prepare for possible surgical re-exploration if output exceeds 200ml/hr for any single hour 3
   • Monitor coagulation parameters and prepare blood products if needed

For Pleural Effusion Management:

1. Control drainage rate:

   • Maximum 1.5L in first hour, then 1L/hr until complete 1
   • Monitor for signs of re-expansion pulmonary edema

2. After initial drainage control:

   • Consider removal when drainage <300-500ml/day in absence of air leaks 1
   • Earlier removal (at <300ml/day) associated with reduced pain, shorter hospital stay 1

Special Considerations

• Patients with cardiac history: Higher risk of hemodynamic instability with rapid fluid shifts; maintain slower drainage rates
• Pulmonary resection patients: Safe to remove chest tubes when drainage is 250-500ml/day 2
• Patients with hypoalbuminemia: May have higher drain outputs; consider nutritional support

Complications to Watch For

• Re-expansion pulmonary edema: Can occur with too-rapid drainage
• Hemodynamic instability: Especially in patients with cardiac comorbidities
• Respiratory distress: May indicate re-expansion issues or fluid overload
• Infection: Prolonged drainage increases infection risk 4

Documentation Requirements

• Hourly drain output measurements
• Characteristics of drainage fluid
• Patient's vital signs and respiratory status
• Interventions performed to control drainage rate

Follow-up Actions

• Reassess need for drain daily
• Consider removal when output decreases to <300-500ml/day 1, 2
• Monitor for signs of fluid reaccumulation after drain removal

By following this structured approach to managing high drain rates, you can minimize the risk of complications while ensuring adequate drainage of pathological fluid collections.