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Consensus Guideline

Pleural Drains in Adults

Trouble shooting UWSD and tubing problems

Air bubbles

Possible cause Action
Normal at end expiration in spontaneously breathing patient with pneumothorax Normal - no action required
Normal at peak inspiration in ventilated patient with pneumothorax Normal - no action required

Continuous bubbling on suction may indicate:

  • disconnected or loose system
  • displacement of pleural catheter
  • bronchopleural fistula if on positive end expiratory pressure (PEEP)

If continuous bubbling, briefly clamp ICC close to the patient's skin. If bubbling is still obvious, clamp at intervals down the ICC to identify the site of the leak.

If disconnection identified re-secure catheter and drainage bottle connection to overcome mechanical leak and then reconnect.

If bubbling ceases during initial clamp, check insertion site as drainage eyelets may be outside of body or stab wound is too large. Apply Jelonet to ensure site is occluded and notify MO.

If the cause cannot be identified - notify MO.

Frothing of fluid

Possible cause Action
Large pleural leak

If on suction. Add an overflow bottle between UWSD and suction outlet to prevent fluid entering the suction unit.

Instil simethicom 1ml into drainage bottle.

Cessation of bubbling

Possible cause Action
Re-expansion of lung Notify MO: CXR to confirm lung re expansion
Blocked ICC/disconnection

Check for clots - follow unit protocol

Check for kinking - straighten

Check for disconnections - reconnect

Perform and record patient assessment

Perform and record patient observations

If not resolved notify senior MO escalate as per Between the Flags

Oscillation (swing of fluid in rod)

Possible cause Action
Fluid level rises on inspiration and falls on expiration [reverse if ventilated] Normal - no action required

Cessation of swing

Possible cause Action
Application of suction Follow unit policy - only if stated disconnect tubing from suction once a shift to ensure swing is still present. Then reconnect as per unit policy.
Re-expanded lung Nil
Blocked or dislodged pleural drain

Check tube location/depth to ensure not out of pleural space

See actions for 'Cessation of bubbling'

Perform and record patient assessment

Perform and record patient observations

Notify Senior MO

Escalate as per Between the Flags

Drainage (fluid loss)

Possible cause Action
Normal or excessive loss

Check amount hourly or more frequently if required

Consider need to change bottle, or for suction application

Rapid or excessive blood stained drainage (>100mls/2 hours)

Possible cause Action

Measure drainage, record vital signs and immediately report to MO

Check for need to change bottle

Check need for urgent blood tests including cross match

Cessation of drainage

Possible cause Action
Restoration of normal lung physiology Notify Resident medical officer (RMO): CXR to confirm lung re-expanded: MO orders to remove drain
Blocked tube See blocked tube under 'Cessation of bubbling'

Increased fluid level in rod

Possible cause Action
Excessive drainage see Rapid or Excessive Drainage
Suction turned off/disconnected

Check suction orders and resume suction as ordered

Check all connections

Bleeding around the insertion site

Possible cause Action
Haemorrhage from small vessels at insertion site Redress with gentle compression: notify MO: observe for further bleeding
Trauma at insertion site As above
Drainage tube dislodged from insertion site Check position of tube eyelets. If external to the skin redress as above and notify MO
Drainage tube inadvertently removed

With gloved hand pinch the sides of the insertion site together and access assistance both medical and nursing to assist and re assess the need for re insertion of new ICC

Do not re-insert the existing pleural drain or new pleural drain via the same insertion site

Aseptically dress the old insertion site with an occlusive dressing (effusion) or gauze taped on three sides (pneumothorax)

Order CXR