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:
| 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 |
|---|---|
| Haemorrhage | 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 |