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12.5 Chest drainage: suction

Essential equipment

  • Personal protective equipment
  • Thoracic high‐volume, low‐pressure suction unit (see Figure 12.31)
  • Two lengths of suction tubing measuring 1–2 metres each
  • Suction canister
  • Portable suction unit to be kept at the patient's bedside in the event of clinical deterioration and need for emergency/resuscitation equipment (if only one suction port available)

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [198], C).
  2. 2.
    Cleanse hands with an alcohol‐based handrub.
    To minimize the risk of infection (NHS England and NHSI [179], C).

Procedure

  1. 3.
    Remove the usual high‐pressure suction unit from the wall suction outlet. Insert the specifically designed high‐volume, low‐pressure thoracic suction unit into the wall suction outlet instead.
    To ensure the correct unit is used. Using the wrong suction unit at high pressures will cause trauma to the lung tissues (Woodrow [290], C).
  2. 4.
    Attach one end of a length of suction tubing to the high‐volume, low‐pressure thoracic suction unit and attach the other end to the suction canister.
    To prevent contamination of the thoracic suction unit filter with pleural fluid. E
    A wet filter could block the system, which has the potential to cause a tension pneumothorax (MHRA [158], C).
  3. 5.
    Attach a length of suction tubing from the suction canister and turn the suction on. Occlude the end of the tubing and check for the presence of low‐pressure suction.
    To check the suction unit is working properly. E
  4. 6.
    Connect the suction tubing (leave one end attached to the suction canister) to the suction port of the chest drain bottle. Adjust the suction pressure to 10 cmH2O.
    To allow the lung to slowly re‐expand without damaging the lung tissues or causing the patient pain or distress (George and Papagiannopoulos [88], C).
  5. 7.
    Monitor for bubbling, swinging and draining of fluid (see Table 12.11), and document.
    To monitor and record the chest drain status (Woodrow [290], C).
  6. 8.
    Check the patient's observations/NEWS and document.
    To detect any change or deterioration in the patient's condition and ensure timely escalation to senior staff if required (RCP [230], C).
  7. 9.
    Slowly titrate the suction up to the pressure prescribed, or to a pressure that the patient can tolerate (maximum of 20 cmH2O)
    To allow the lung to slowly re‐expand without damaging the lung tissues or causing the patient pain or distress (George and Papagiannopoulos [88], C).

Post‐procedure

  1. 10.
    If the patient needs to leave their bed space, disconnect the suction tubing from the chest drain suction port. Reconnect it when the patient is back at their bed space. Ensure the tubing is properly reconnected and the suction unit is on at the prescribed pressure.
    To ensure a patent and safe system. If the tubing is reattached but suction is not turned on, air is unable to escape from the bottle, which could result in a tension pneumothorax. E
  2. 11.
    Record the addition of suction and the set pressure on the chest drain observation chart and in the nursing documentation.
    To keep an accurate record of the amount of pressure applied. E
  3. 12.
    Observe for any change in the patient's respiratory status and recheck the patient's observations/NEWS. Escalate any concerns or deterioration immediately.
    To identify any concerns or clinical deterioration early and ensure timely escalation to senior staff if required (RCP [230], C; Woodrow [290], C).
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