An evidence‐based approach to drainage of the pleural cavity: evaluation of best practice

Abstract

Recent surveys have uncovered major variations in key aspects of intercostal drain management, suggesting that decisions are being made on individual preferences without resorting to sound evidence. We provide an up-to-date review of the best practice with evidence-based recommendations and expert consensus views. The following aspects of chest drain management have been addressed: indications for drainage, insertion technique, complications, management of an indwelling chest drain, indications and technique for removal. The emphasis in this review is that safe intercostal drain practice relies upon adherence to a few important principles. Furthermore, when in doubt, particularly with a complex thoracic problem, one should seek prompt specialist advice.

Practical Aspects About Closed Chest Drainage Care: A Literature Review

“…This negative pressure moves the drained collected effusion through the drainage tube in some millimetres (at this moment the oscillation or swinging of the debit can be observed). This oscillation can be also presented in the water-seal drainage system 9,12,16,18,20 .…”

“…Nonetheless, the purpose of the system is to allow for drainage from the pleural cavity to the outside and at the same time prevent the entry of atmospheric air into the pleural cavity. The chest drainage also aims to maintain or restore the negative pressure of the pleural space [2][3][4]12,16,18,20 . For each case, there are 3 types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system [7][8][9][10][11][12][13][14][15][16][17][18][20][21][22] .…”

“…At this time, this positive intrapleural pressure makes air moves out of the lungs by flowing down its pressure gradient, while the pleural effusion is forced to move throughout the drainage-tube to the collector 9,12,16,18,20 .…”

“…In other words, the level of water in the water seal chamber represents the amount of negative pressure being generated ( Figure 3A) 9,11,13,17,19,20 . In this type of drainage, the bottles and collection apparatus of the system must be kept 30-40 cm below the level of the chest to prevent backflow and to promote gravity drainage 8,11,[18][19][20] . However some reports only mention that The drainage bottle must be kept below the patient's chest level to prevent fluid re-entering the pleural space 9 .…”

Comparison between Flutter Valve Drainage Bag and Underwater Seal Device for Pleural Drainage after Lung Surgery

“…Surgeons manage postoperative drainage differently and often decisions are made on individual preferences without resorting to sound evidence (1).…”