Adult Medical Emergency Handbook - Scottish Intensive Care Society

7. Care of patient with an intercostal drain
• Rapid full expansion of a completely collapsed lung may lead to
pulmonary oedema. For very large effusions, clamp the tube for
1 hour after 1.5 litres have drained, before allowing free drainage.
Make sure all staff are aware the tube is clamped and what time
the clamp is to be removed.
• Instruct the patient to keep water bottle below waist level, to
remember it is attached and not to pull it accidentally.
• For mobile patients, a weighted metal stand should be used to
carry the bottle and to prevent it falling over.
• Prescribe adequate analgesia (pethidine or morphine may be
required) – remember the surgical “injury” you have caused is
equivalent to a stab wound.
• Adjustment of position: If drain is too far in, it is acceptable using
sterile technique and after careful antiseptic swabbing, to loosen
the retaining stitch and retract the drain a few cm before resecuring
it, taking care not to withdraw so far that the side holes
leave the pleural space.
• The drain should NEVER be advanced further into the chest after
the initial insertion – this carries infection forward into the pleural
space.
• Only clamp a chest drain if draining a very large effusion (see
above), if the bottle breaks or the tube becomes disconnected.
• If a patient with a chest drain in situ requires transfer by
ambulance a trained nurse with experience in the management of
chest drains must be part of the escortAlastair Innes, April, 2007
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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