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Surgical drains are used to monitor for a postoperative leak or abscess, collect normal physiologic fluid or to minimize dead space. Table 47-1 lists various types of drains, as well as their locations and indications. Although caregivers should know the location and purpose of drains, they should not manipulate surgical drains without input from the surgeon who placed them.

Table 47-1 Surgical Tubes and Drains
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Practice Point
  • Although caregivers should know the location and purpose of drains, they should not manipulate surgical 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 38 French and are typically placed between the fourth and fifth intercostal space in the anterior axillary line. However, location may vary according to the type of surgery. The tubes can be straight or angled. Angled tubes are used primarily to collect fluid and are usually placed near the diaphragm.

The tubes are connected to a collecting system with a three-way chamber (Figure 47-1). The water chamber holds a tall 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 left without suction on water seal. The third chamber is the collection chamber which should be marked at regular intervals to monitor fluid drainage.

Figure 47-1

Chest drainage collection systems. (Reproduced, with permission, from Hall JB, Schmidt GA, Wood LDH. Principles of Critical Care. 3rd ed. New York: McGraw-Hill; 2005: Fig. ...

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