Chest Drains

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 www.pdfcoke.com/cpradheep

Causes  R.T.A.

 Fracture Ribs  Barotrauma  Infections  Emphysema, Cystic fibrosis  Blunt and Sharp injuries

 Accidentally during some medical procedures

over the chest wall www.pdfcoke.com/cpradheep

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) www.pdfcoke.com/cpradheep

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. www.pdfcoke.com/cpradheep

Physiotherapy Tools PHYSIO

Breathing Coughing Exercise

Position

Manual Tech.

RoM Exercise

CPAP Triflow Man.Hyp

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Reference  Ciesla ND & Murdock KR (2000): Lines, tubes, catheters, and

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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 www.pdfcoke.com/cpradheep

Thanks

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