Reducing morbidity from chest drains

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7085.914 (Published 29 March 1997) Cite this as: BMJ 1997;314:914

Knowledge of basic principles and use of appropriate equipment would help

  1. Jonathan Hyde, Registrar in cardiothoracic surgerya,
  2. Timothy Sykes, Registrar in general surgerya,
  3. Timothy Graham, Consultant in cardiothoracic surgerya
  1. a Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH

    The insertion of an intercostal chest drain to relieve the pleural cavity of unwanted air or liquid is a common procedure. It is simple to perform and should be associated with a low mortality and morbidity. However, unnecessary problems are often encountered, both during and after the procedure.

    Most hospital doctors will, at some stage, insert a chest drain, either urgently in cases of trauma or electively for a pneumothorax or pleural effusion. An adequate understanding of the anatomy and pathophysiology of the pleural space is vital, as is proper teaching of the technique of insertion and subsequent management of chest drains.1 2 3

    The aim of drain insertion is to restore and maintain the negative intrathoracic pressure necessary for lung expansion and drainage of the pleural cavity.4 The physiological mechanisms maintaining full expansion depend on removal of excess liquid and gas from this space. The basic principle of chest drainage is to ensure this by re-establishing the negative intrapleural pressure. When at rest (that is, at functional residual capacity), the elastic forces of the chest wall and lung try to separate the visceral and parietal pleural layers, and create a …

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