<b>Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná

Abstract

ABSTRACT. The purpose of chest drainage is to allow lung re-expansion and the reestablishment of the subatmospheric pressure in the pleural space. Properly managing the drainage system minimizes procedure-related complications. This prospective observational study evaluated adult patients undergoing water-seal chest drainage, admitted to our hospital and accompanied by residents and tutors, aiming to check their care. One hundred chest drainages were monitored. The average age was 38.8 years old. The average drainage time was 6.7 days. Trauma was the prevalent cause (72%) for the indication of pleural drainage. The obstruction of the system occurred in 6% of the cases; 5% subcutaneous emphysema, 1% infection around the drain; 5% accidental dislodgement of the drain, and in 5% of the patients, there were some complications when removing the drain. Failures in chest drainage technique and management were present, and reflected in some complications that are inherent to the procedure, although it is known that there are intrinsic complications. This study aimed to assess the management of closed chest drainage systems and standardize the care provided in such procedure.Keywords: chest drainage, chest tubes, thoracostomy, thoracic surgery.Protocolo institucional para padronizar cuidados com o dreno de tórax, desde a intervenção cirúrgica até os cuidados de enfermagem, em hospital regional do norte do Paraná RESUMO. O objetivo da drenagem torácica é possibilitar a reexpansão pulmonar e o restabelecimento da pressão subatmosférica no espaço pleural. O manejo adequado do sistema de drenagem minimiza as complicações relacionadas ao procedimento. O presente estudo observacional prospectivo avaliou pacientes adultos submetidos à drenagem torácica em selo d'água, internados em nosso hospital e acompanhados por médicos residentes e preceptores, com o objetivo de verificar o manejo com eles. Foram observadas 100 drenagens torácicas. A faixa etária média foi de 38,8 anos. O tempo médio de drenagem foi de 6,7 dias. Houve predomínio da causa traumática (72%) na indicação de drenagem pleural. A obstrução do sistema esteve presente em 6% dos casos; em 5%, houve enfisema subcutâneo; em 1%, infecção peridreno; em 5%, deslocamento acidental do dreno e, em 5% dos pacientes, houve complicação na retirada do dreno. Falhas na técnica e no manejo de drenagem torácica estão presentes em nosso serviço, refletidas em algumas complicações inerentes ao procedimento, embora saibamos que haja complicações que lhe são intrínsecas. O objetivo do estudo foi avaliar o manejo dos sistemas de drenagem torácica fechada e padronizar o protocolo para os cuidados com esse procedimento.

Practical Aspects About Closed Chest Drainage Care: A Literature Review

“…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] .…”

“…Each single collector plays a different role in the drainage system. Adjustment between the drain and the tube from the collectors connected to the bottle under water seal by using a large-diameter intermediate connector 7 .…”

“…Attention should be given to the inserted sutures that anchors the drain in place and perform a fixed dressing in the tube site 7,8,11,20,21 and use dry gauze pads around and over drains and tubes to protect them from damage or external contamination. The chest drain site should be assessed at least daily for signs of systemic or local infection 10,11,20 .…”

“…(Figure 5 C-D) 11,20 However clamping a chest drain tube can increase the risk of a tension pneumothorax. Therefore, clamping the tube must be avoid 7,9,20 regarding the same aspects, the description of techniques used to maintain drain patency (e.g. 'milking' as fanfolding the drainage tubing into segments and squeezing and 'stripping' as manual compression of the chest drain tubing from the chest wall towards the collection chamber often using a roller device) is not consensuous, thus not recommended 7,9,[14][15][16] .…”

“…Properly managing the drainage system minimizes procedure-related complications 7,8 . Therefore, strategic educational initiatives are in place to ensure knowledge deficits are focus on a chest drain management.8, A greater awareness of the areas of knowledge weakness regarding chest drain management will facilitate targeted educational initiatives in the future, ensuring improved chest drain management 9 .…”