A regional survey of chest drains: evidence-based practice? (original) (raw)
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Management of chest drains: A national survey on surgeons-in-training experience and practice
Nigerian Journal of Surgery, 2015
Thoracic trauma and many pleural diseases are commonly treated with tube thoracostomy. On account of its vast clinical utility, the procedure has become a mandatory skill not only for surgeons, but also for intensivists and emergency physicians. [1] However, tube thoracostomy is not without its own complications. [2] Early and late complications have been shown to be as low as 3% and 8% respectively in trained hands. [3] Hence, we undertook this study to ascertain the level of experience and expertise of surgeons-in-training in Nigeria in performing tube thoracostomy safely. MAterIAls And Methods Accredited Departments of Surgery in four university hospitals in Nigeria were selected for the study by simple random sampling.
Chest drain insertion is not a harmless procedure--are we doing it safely?
2010
The incorrect insertion of a chest drain can cause serious harm or even death. All elective drains should be inserted in the 'triangle of safety' in line with the British Thoracic Society guidelines. The aim of this study was to test the awareness of junior doctors involved in inserting chest drains with these guidelines. Fifty junior doctors were questioned. Participants were asked to grade their experience of chest drain insertion and mark on a diagram where they felt was the optimum site for inserting a drain for a large pneumothorax in an elective situation. Only 44% (n=22) of doctors indicated they would insert a chest drain within the safe triangle. Level of experience, seniority and specialty all had an effect on knowledge of the correct site. Of those who had inserted drains unsupervised, 48% (n=16) would site the drain outside the safe triangle as would 75% (n=6) of those who had performed the procedure supervised. Only 25% of medics knew where to insert a drain, compared with 58% of doctors working in surgery. The majority of junior doctors do not have the basic knowledge to insert a chest drain safely. Further training in this procedure is needed for junior doctors.
Chest drain care bundle: Improving documentation and safety
BMJ Quality Improvement Reports, 2015
Chest drain insertion is a common advanced procedure with a significant associated risk of pain, distress, and complications. Nationally, audit and recommendations from leading bodies have highlighted a number of safety concerns around chest drain insertion. Audit work has demonstrated poor levels of documentation; particularly around use of premedication, use of ultrasound guidance and consent. This has obvious potential consequences for patient safety and thus is an important target for improvement work. This project quantifies current standards of documentation and aims to improve this through a combination of accessible and easy to read guidelines, education, and the introduction of a chest drain insertion bundle. National best practice standards were identified through review of national guidance. Drain insertion was prospectively analysed over a three month period to establish baseline standards of documentation. This initial work was presented and a bundle and clinical guidelines produced. Chest drain insertion was then reaudited and assessed for improvement. Results demonstrated an improvement in many areas of documentation, pushing local results above the national average. However, only 40% of cases used the new bundle due to a mixture of staff rotation and an unexpectedly high proportion of drains inserted in non targeted areas including the emergency department, theatre, and intensive care. Despite this, the introduction of accessible guidance and bundle has significantly improved chest drain insertion documentation to the benefit of all.
Nurses’ knowledge of chest drain care: an exploratory descriptive survey
Nursing in Critical Care, 2005
Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Chest drains are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidencebased nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses. Several service-led options exist with regard to improving knowledge in this area, such as service study days as well as ward-based tutorials. However, in an era of increasing accountability together with the impetus for each nurse to provide evidence-based care, it is crucial for individual nurse responsibility in the pursuit of knowledge in this area. Nurses must be supported by local practice development and through personal portfolio use to identify gaps in knowledge and seek appropriate training and resources.
Nurses’ Knowledge Levels of Chest Drain Management: A Descriptive Study
Eurasian Journal of Pulmonology, 2017
INTRODUCTION Chest drainage is defined as discharging air, water, blood, and other fluids by inserting a tube into the pleural or mediastinal cavity. Chest drainage is generally used in the treatment of patients who have undergone heart and chest surgery or chest trauma (1). Chest drainage is an invasive operation; insufficient knowledge and experience of the healthcare team may lead to unwanted complications (2). The mismanagement of chest drainage may cause series of complications such as increased morbidity, extension of duration of hospital stay, and even death in some cases (3). The insertion of a chest tube in a patient using the aseptic technique is the physician's responsibility. However, as long as the chest tube is kept inserted, the nurses' responsibilities include (i) monitoring the drainage bottle and suction level, (ii) recording the quantity and content of drainage, (iii) administering wound care and follow-up of pain, and (iv) providing information and support to the patient (4). The applications involving these aspects of nursing in the management of patients with chest tubes are inconsistent, which leads to distrust regarding nurses during patient care (5).
Chest drains: prevalence of insertion and ICU nurses’ knowledge of care
Heliyon, 2021
Background: Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses' level of knowledge regarding chest drain care. Methods: Anon-experimental descriptive design using cross-sectional survey was used for evaluating nurses' knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion. Data was analysis using the Statistical Package for Social Sciences (SPSS) program. Results: The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n ¼ 134) followed by pleural effusion (6.3%, n ¼ 10). The results revealed that the mean score for nurses' knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n ¼ 107 vs. 51.1%, n ¼ 115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%). Nurses from private hospitals had significantly higher (M ¼ 16, SD AE 2.77) level of knowledge (F[2, 222] ¼ 8.467, p < .001) than nurses from other sectors. Conclusions: Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended.
Journal of Thoracic Disease
Background: Chest drain management is a variable aspect of postoperative care in thoracic surgery, with different opinion for air and drain volume output. We aim to study if acceptable safety was maintained using air leak criteria alone. Methods: A 9-year retrospective analysis of protocolised chest drain management using digital drain air leak cut off less than 20 mL/min for more than 6 h for drain removal in patients undergoing general thoracic surgery. We excluded patients if a chest drain was not required nor removed during admission or if patients underwent volume reduction or pneumonectomy. Withdrawal criteria were suspected bleeding or chylothorax. Postoperative films were reviewed to document post-drain removal pneumothorax, pleural effusion, and reintervention (drain re-insertion). Results: Between 2012 and 2021, 1,187 patients had thoracic surgery under a single surgeon. Following exclusion and withdrawal criteria, 797 patients were left for analysis. The mean age [standard deviation (SD)] was 61 [16] years and 383 (48%) were male. Median [interquartile range (IQR)] duration of drain insertion was 1 [1-2] day with a median length of hospital stay of 4 [2-6] days. Post-drain removal pneumothorax was observed in 141 (17.7%), post-drain removal pleural effusion was observed in 75 (9.4%) and re-intervention (reinsertion of chest drain) required in 17 (2.1%). Conclusions: Our results demonstrate acceptable levels of safety using digital assessment of air leak as the sole criteria for drain removal in selected patients after general thoracic surgery.
Monaldi Archives for Chest Disease
Persistent air leak and prolonged drainage are recognized complications of thoracic surgery, increasing hospital stay and costs. Patients can be discharged with a chest drain and followed up in a nurse-led clinic. We reviewed such patients and the rate of readmission after discharge to assess the effectiveness of the drain follow up clinic. Retrospective review of our prospective database for 22 months (March 2019 to January 2021). Analysis focussed on indication and duration of chest drainage, complications, and readmission for any reason. 62 patients (representing 5% of all thoracic surgery patients) were discharged with a chest drain. Median age was 67 years (range 22-85 years), 24 females and 38 males. 52% underwent video-assisted thoracoscopic surgery, 27% had a thoracotomy, and 21% had bedside chest drain insertion. Following discharge, median duration of chest drainage was 11 days [interquartile range (IQR) 7-18.75 days]. Patients had 106 review episodes in the ward-based nur...
We prospectively audited the implementation of a protocol for management of air-leaks and intercostal drains after thoracic surgical procedures. Out of the 99 patients who underwent thoracic surgical procedures during a 3-month period, 41 presented a postoperative air-leak on day 1. The protocol was strictly followed in 95% of the cases. The median drainage-time and hospital-stay were 3 and 4 days, respectively. The incidence of insertion of postoperative drains was 3%. Most of the nursing staff found the protocol user-friendly and easy to apply. A protocol for the management of postoperative air-leaks and intercostal drains can be implemented with high-compliance low complications. q 2003 Elsevier B.V. All rights reserved.