The Nursing Management of Chest Drains; A Systematic Review

Abstract

Introduction Chest drains are commonly used for patients who have undergone cardiac or thoracic surgery or who have suffered chest trauma. The principal purpose of chest drains is to maintain cardiorespiratory function and haemodynamic stability by draining the pleural and mediastinal spaces of air, blood or other fluids. While there are many publications addressing this issue, there had been no attempt to systematically collect, appraise and summarise current research. This systematic review was conducted to summarise the best evidence on the nursing management of chest drains. Method/Objective The objective of this review was to present the best available evidence related to the nursing management of chest drains. The specific review questions related to the management of: 1. Dressings 2. Chest drain tubing 3. Chest drain bottle/unit 4. Disconnection 5. Removal of chest drain Inclusion criteria Types of participants -hospitalised patients with chest drains Types of intervention -those related to the management of chest drain dressings, tubing, drainage units, disconnection and removal. Types of outcome measures -those related to the promotion of drainage, lung expansion and comfort, and to the minimisation of complications. Types of studies -randomised controlled trials (RCT) Search strategy The search covered CINAHL, MEDLINE, Current Contents, Cochrane Library, Embase, Expanded Academic Index and PsychLit, utilising a range of optimal search terms. Critical appraisal Methodological quality of RCTs was assessed by two people using a checklist that focused on sources of bias as a result of the selection of participants, their treatment, attrition and measurement of outcomes. Data synthesis As meta-analysis was not possible, studies were summarised by narrative and supported by graphical and tabular presentation of results. Results The search uncovered only 8 RCTs that addressed some aspect of chest drain management. Major findings of this systematic review are: -there is a lack of rigorous research in all areas of chest drain management, particularly with minors (those aged under 18 years) -the literature suggests that practices vary amongst institutions and there are often no written protocols to guide practice -the presence and removal of a chest drain is a very painful experience -the literature suggests that pain practices vary amongst institutions and are often inadequate Conclusion In conclusion, this Systematic Review recommends that there is a need for rigorous research in all areas relating to the nursing management of chest drains.