Review Note
Last Update: 02/27/2025 04:32 AM
Current Deck: ACG Part 2::Thoracic SSU
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Commit #291085SS_TS 1.17 Discuss the management of chest drains and pleural drainage systems in the postoperative period
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Commit #291085
3 Chamber chest drain with the addition of 4th chamber in case of suction failure.
Chamber 1: Allows drainage of fluid/pus.
- Separates from the underwater seal so allows fixed under water seal, additional pressure is not generated with drainage.
- Prevents formation of froth that occurs when air bubbles through the protein of pleural fluid
- Does decrease the efficiency of air drainage without suction as there is a larger volume of compressible air.
Chamber 2: Under water seal.
- When patient inhales, water prevents entrainment of air back into pleural cavity
Chamber 3 : Negative pressure regulator
- Depth of the vent tube regulates the negative pressure applied
- Effective for both pneumo and pleural effusion.
- Without addition of 4th chamber, no fail safe for suction failure
Chamber 4 : Drain failsafe
- Disconnected from suction and connected to atmosphere,
- Allows failure safe if suction blocks and prevent pneumothorax
Atrium is a type of ‘dry suction’ underwater seal drain. Instead of 3rd chamber with depth of the vent tube adjusting suction pressure, is done by adjusting A valve.
Management Postoperatively :
- Position : placed below patient to allow fluid to drain via gravity, if raised above patient clamp to prevent return of drained fluid to chest
- Clamp if pleural effusion >1.5L per day to prevent re-expansion pulmonary oedema.
- Thoracic surgical opinion should be sought if persistent air leak or failure to re-expand lung in 4 days. (consider bronchopleural fistula)
https://derangedphysiology.com/main/required-reading/intensive-care-procedures/Chapter-262/underwater-seal-chest-drain-system