Patient activity, hygiene, pain relief
- Select positions for the patient that avoid kinking and occlusion of tubing.
- Offer rolled towels or pillows to splint the chest on the affected side as required.
- Provide adequate analgesia to patients to enable deep breathing (hourly) and regular range of motion arm exercises on the affected side.
- Encourage patients to mobilize several times a day and to sit out of bed for meals.
- Avoid pressure areas by regular repositioning the patient and where required the use of bariatric devices.
- Apply anti embolic stockings if mobility is reduced.
- Advise patient of their responsibilities regarding care of the pleural drain and the need to maintain the drainage system below the chest especially when mobilizing.
- Constipation and subsequent straining to empty bowel should be avoided in this patient group.
- Patients may shower with assistance - if on suction check with MO if extended tubing is required or if brief discontinuation of suction is preferred for showering.
- Refer to physiotherapy if additional mobility assistance is required.
The decision for removal must be documented by the MO in the progress notes. Pigtail drains must be uncoiled prior to removal. Follow manufacturer's instructions regarding removal of drainage device, distance from the chest to cut the catheter and release the string. Failure to uncoil a pigtail drain prior to removal can cause severe pain and internal tissue damage to the patient.8
Prior to drain removal, check INR is =50 x109/L.
Check when anticoagulants were last given in all patients with anticoagulation therapy. The risk of haemorrhage will be reduced if removal of the drain occurs more than six hours since last dose of anticoagulants.
Recognise that the perception of the procedure will be unique for each patient.