Chest Drains

Pradeep Chockalingam
Physiotherapist

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Definition

Chest drain is a process by which air, blood,

pus, or other secretions are removed from the

chest cavity.

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Types

 Chest Cavity Drain (Pleural Space)

 Pleural Drain / Tape

 Pericardial Drain / Tape

 Mediastinal Drain

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Chest Cavity Drain

 Pneumothorax

 Haemothorax

 Haemopneumothorax

 Pyothorax

 Pyopneumothorax

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Causes
 R.T.A.
 Fracture Ribs
 Barotrauma
 Infections
 Emphysema, Cystic fibrosis
 Blunt and Sharp injuries
 Accidentally during some medical procedures
over the chest wall

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Types of Pneumothorax
 Simple
 Open
 Tension

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 Site of Drain

 Meeting point of

mid-axillary line and

the line drawn from

the nipple (4th or 5th

intercostal space)

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Why 4th or 5th IC space ?
 During expiration the diaphragm elevates to the level
of 5th rib

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Underwater Seal Chest Drain
 It is a simple mechanism by

which using water & gravity

as an one way valve to allow

the air in the pleural cavity to

escape by bubbling and

preventing it from

re-entering into the pleural

cavity.

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Complications

 Blocking of tube

 Leaking & surgical emphysema, infection

 Shallow breathing

 Fear of pain & Pain

 Stiff Shoulder & Neck

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Points to be consider
 Adequate Pain relief.
 Check for water column swing, level &
bubbling.
 Check for signs of leak, surgical emphysema,
signs of infection.
 Do not lift the drain above the chest level.
 Do not clamp the drain.

Treat patient as a whole.

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Physiotherapy Tools

PHYSIO

CPAP
Breathing Manual
Coughing Position RoM Triflow
Exercise Tech.
Exercise Man.Hyp

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Reference
 Ciesla ND & Murdock KR (2000): Lines, tubes, catheters, and
physiologic monitoring in the ICU: Car.pul Phy Ther Journal:
Vol11, No 1, page 16-25
 Cystic Fibrosis Trust (2002): Clinical Guidelines for the
Physiotherapy Management of Cystic Fibrosis: Cystic Fibrosis
Trust, ISBN: 0-9540536-4-8
 Gallon A (1998): Pneumothorax: Nursing Standards: Vol 13, 10,
page 35-39
 Laws D et al (2003):BTS guidelines for the insertion of a chest
drain: Thorax: (2003)58(Suppl 2) page:ii53-ii59 & (2005)60
page:152
 Senekal M et al (1995): Penetrating stab wounds of the chest
when should chest physiotherapy commence?: A comparative
study: S Afr j surg: Vol 33,No 2, page: 61-66

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Thanks

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