A chest drain is a narrow tube that is inserted between the ribs and sits in the space between the lung and the chest wall.
This space is lined on both sides by a membrane called the pleura and is known as the pleural cavity or pleural space.
A chest drain is inserted when air, fluid, blood or pus has collected in the pleural space.
The external end of the chest drain tube is attached to a bottle which acts as a seal to prevent anything from leaking back into the pleural space.
You need a chest drain if you have an air leak (pneumothorax), a collection of fluid (pleural effusion), pus (empyema) or blood (haemothorax) in the pleural space.
Any of these can cause problems with breathing and can stop the lungs from working properly. The chest drain will allow the fluid or air to leave the body and allow your lung to re-expand.
Once a chest drain has been inserted the external end is connected to a bottle. The fluid or air travels down the tube, into the bottle.
There are 2 types of chest drain bottle.
The first type contains a small amount of water, which acts as a seal preventing air or fluid coming back up the tube into your chest. Alternatively, an electronic chest drainage device may be used (Thopaz+ machine), which can deliver suction (to help the lung re-expand) and allows the doctors to measure if there is any ongoing air leak between the lung and pleural cavity.
You will either sit with your head and arms resting on a pillow on a table or lie on your bed with your arm above your head. The drain is usually put into the side of your chest below the armpit. Before the procedure starts, an ultrasound may be performed to choose the best place to insert the drain.
Ultrasound is painless and a cool gel is used on the skin to ensure good contact for the ultrasound tip. You may be offered painkillers to take before the procedure starts. The procedure is performed using an aseptic technique to minimise the risk of infection. Your skin is cleaned with an alcohol-based liquid to kill any bacteria.
A local anaesthetic is then injected into the skin to numb the area where the tube is to be inserted, which can ‘sting’ temporarily but resolves quickly. A small cut (approximately 2-3mm) is then made in the anaesthetised area. It is normal to feel a sensation of pressure and tugging as the drain is gently eased into the chest, but this should not be painful.
The chest drain is held in place with stitches and the exit site is covered with a waterproof dressing. The end of the tubing is connected to a drainage bottle. Your chest drain will be monitored regularly. You may be asked to cough, or take a deep breath. This enables the doctor or nurse to ensure the drain is still functioning. You will be given regular pain relief while the drain is in place. Pain may impair your movement and breathing which may prolong the time your lung takes to expand therefore it is important to report any pain and keep it under control.
How long the chest drain will be needed depends on your condition and how well you respond to treatment. Removing the drain is a simple procedure. Once all the dressings are removed, the stitch is cut and the drain is gently pulled out.
The doctor or nurse may ask you to breathe in a particular way while the drain is removed. Removal of the drain can feel a little uncomfortable but only lasts a few seconds. In some cases a stitch is left where the drain has been.
This need to be removed after 7 to 10 days. If you experience discomfort after the drain has been taken out you can take simple painkillers. If you develop any other worsening symptoms (lots of pain, difficulty breathing or a temperature) you must tell the doctors and nurses
In most cases the insertion of a chest drain is a routine and safe procedure. Most people find their breathing is much easier once the chest drain is in place. However, like all medical procedures, chest drains can cause some problems:
• Chest drains sometimes fall out and may need to be replaced. This risk is minimised by stitching the drain in place and covering it with a secure dressing. You can also help by following the suggestions ‘Looking after your chest drain’.
• Occasionally it is not possible to site the drain correctly and an alternative procedure may be required. Your doctor will talk this through with you if this happens.
• Pain: Most people (1 in 2 people having a drain) experience some discomfort from their chest drain but painkilling medication should control this.
• Infection: Sometimes chest drains can become infected but this is uncommon (about 1 in 50 patients). If you feel feverish or notice any increase in pain or redness around the chest drain, inform your nurse or doctor.
• Bleeding: A bruise at the site of insertion occurs commonly. Very rarely (1 in 500 patients), the chest drain may accidentally damage a blood vessel and cause serious bleeding. If this does happen it might require an operation or other intervention to stop it. If you have any more questions, please ask a member of the team.
Looking after your chest drain.
As the fluid or air around the lung drains you should be able to move more easily. There are a few simple rules that you can follow to minimise any problems.
You can move and walk around with a chest drain but you must remember to carry the drainage bottle with you.
Always carry the bottle below the level of your waist. If it is lifted above your waist level fluid from the bottle may flow back into the pleural space. Whilst in bed keep the drainage bottle on the floor.
• Do not pull on your chest drain or tangle it around your bed.
• Do not swing the bottle by the tube.
• Try not to knock the bottle over.
• If your chest is painful please tell your nurse.
• If you feel your tube may have moved or may be coming out please tell your nurse.
• Inform your nurse if you feel any increased shortness of breath.
