Nursing Management of Patients with Chest Drains

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NURSING MANAGEMENT OF PATIENTS WITH CHEST DRAINS Chest drains are one-way draining medical devices that allow fluid or air accumulations to be drained from the chest cavity. Normally the chest drains are inserted following an x-ray report that confirms the presence of air or fluid in the chest cavity. The rationale for the chest drain insertion is that the drain will help restore the normal function of the lungs, by allowing the drainage of the air or fluid collected in the pleural space. There are a number of indications for drains insertions such as: pneumothorax, pleura effusions, haemothorax or post cardio-thoracic surgery. To understand completely the importance of inserting chest drains, when required, we have to look closely at the entire mechanism of breathing. When breathing, the diaphragm descends and contracts, while the lower ribs move upwards and outwards, and the upper ribs and sternum move upwards and forwards. This process allows oxygenation of haemoglobin in the red blood cells. Across the NHS there are two types of chest drains, each with its particularities and ease of use. The first one is the Heimlich device, which consists in a rubber one-way flutter valve connected to a standard bottle. It has been noticed that their management of fluid can be rather difficult for nurses. The second type of drain is the water-sealed device which uses an underwater seal to prevent air from being drawn back into the chest cavity. In the management of the chest drains the nursing factor holds an important position. The nurse has an implication in the process, from the decision of insertion until the decision of removal. The nursing factor will be constant, throughout the procedure and after, and will include looking after the needs of the patient as well. Nurses will
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