Paediatric chest drains: past, present and percutaneous

Abstract

membrane of the embryonic coelomic cavity is invaginated by the growing lung buds. The membrane covering the exterior surface of the formed lung is called visceral pleura; that lining the chest wall being the parietal pleura. The coelomic cavity remains as the slit-like pleural space and contains a thin film of pleural fluid, produced by the pleura. This fluid enables the two layers of membrane to slide over each other during respiration. A negative (subatmospheric) pressure of between Ϫ2.5 mmHg and Ϫ6 mmHg, exists in the pleural space throughout the respiratory cycle (Ganong, 1993). Should the integrity of the pleura be disrupted, the negative intrapleural pressure is lost and air is sucked into the intrapleural cavity creating a pneumothorax. This, in turn, causes the affected lung to collapse due to its inherent elastic recoil. If air continues accumulating in the intrapleural space, the intrapleural pressure on the affected side will approach atmospheric pressure, pushing the mediastinal contents away towards the unaffected side: the clinical manifestations of a tension pneumothorax. This condition is lifethreatening. Air entering the pleural space during inspiration is unable to escape during expiration due to the presence of a valve like communication in the pleura. This accumulation of trapped air within the pleural space collapses the lung on the affected side, compresses the mediastinal structures, impairs venous return to the heart and cardiac output subsequently diminishes. To relieve or decompress this tension pneumothorax a 16-guage cannula (or larger) should be attached to a syringe and inserted through the anterior chest wall in the second Trauma 2005; 7: 163-170The authors present a review of the pathophysiology of pneumothoraces, the indications and the procedures required for the insertion of chest drains, and review paediatric practice using the recently developed Seldinger-style percutaneous chest drains.

Nurses' knowledge of chest drain management in an Irish Children's Hospital

“…() caution that clamping can convert a simple pneumothorax into a life‐threatening tension pneumothorax. Parslow and Sandell () advocate clamping the chest drain when changing bottles, while in the case of accidental tube disconnection, Brandt et al . () advises clamping the drain close to the chest wall and quickly unclamping on reconnection.…”