Aim:

To remove drain without allowing air to enter the pleural cavity.

When to remove:

No air leak for 48 hours - do not clamp drains to test

Fluid < 200cc per day

Empyema pus - when no longer purulent. May “inch” drain out over a few weeks

    Preparation for removal:

1. •Assemble equipment
   

2. •Basic dressing pack which includes gloves
   

3. •Suture cutter
   

4. •Dressing pads
   

5. •Strips of 3 inch adhesive tape
   

6. •Saline to clean area of clots, crusts etc.
   

7. •Get an assistant to help
   

8. •Place patient semi-recumbent in bed. Encourage them to use PCA.
   

9. •Remove dressings, disentangle purse-string and place one throw of knot
   

10. •Clamp drain - to prevent fluid siphoning onto floor!
    

    Removing the drain:

1. •While assistant holds drain, cut stay suture - NOT the pursestring
   

2. •Ask assistant to hold a pad over the site. This will close off the skin incision. Drains placed at surgery should have been tunnelled so pressure along the track seals it as the drain is removed
   

3. •Rehearse the process with the patient
   

4. •Ask the patient to take a “deep breath in … let it out … take a deep breath in and hold it”. [The first reaction to the pain of removal will be inhalation. If already in full inhalation no further air can be entrained]
   

5. •As the breath is held, pull the drain out swiftly in one smooth movement. [The drains have side holes as well as an end hole. If the drain is taken out slowly air will pass into the chest through these holes.]
   

6. •Tie the pursestring [If there is no pursestring, the pad may be enough to seal. If not the skin can be pinched around the drain with one hand while the drain is withdrawn and a suture is placed with the other]
   

7. •Place tapes over the assistant’s dressing pad
   

8. •Tell the patient they can breath normally.
   

9. •Arrange a check X-ray