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INTRODUCTION

Surgical drains are used to monitor for postoperative leaks or abscesses, collect normal physiologic fluid, or to minimize dead space. Table 45-1 lists various types of drains, with their indications for use. This chapter will review the most common types of surgical drains, and the basic care of these drains from a hospitalist perspective.

TABLE 45-1Surgical Tubes and Drains

PRACTICE POINT

  • Hospitalists should know the location and purpose of all surgical drains in their patients, but should not manipulate these drains without input from the surgeon who placed them.

CHEST TUBES

Chest tubes are placed in the pleural space to evacuate air or fluid. They can be as thin as 20 French or as thick as 40 French (for adults). Chest tubes are typically placed between the fourth and fifth intercostal spaces in the anterior axillary or mid-axillary line, however, location may vary according to the indication for placement. The tubes can be straight or angled.

The tubes are connected to a collecting system with a three-way chamber. The water chamber holds a column of water which prevents air from being sucked into the pleural space with inhalation. The suction chamber can be attached to continuous wall suction to remove air or fluid, or it can be placed on “water seal” with no active suction mechanism. The third chamber is the collection chamber for fluid drainage.

Indications for a chest tube include pneumothorax, hemothorax, or a persistent or large pleural effusion. Pneumothorax and hemothorax usually require immediate chest tube placement. Chest tubes are also commonly placed at the end of thoracic surgeries, to allow for appropriate re-expansion of the lung tissue.

A chest x-ray should be obtained after any chest tube insertion to ensure appropriate location. Chest tubes are equipped with a radiopaque line along the longitudinal axis, which should be visible on x-ray. Respiratory variation in ...

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