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Pleural drain

Principle

Evacuating fluid or air from the pleural cavity when more straightforward measures, such as exsufflation or pleural puncture, do not produce the required result. A pleural drain may also be inserted following a pleuroscopy or to allow introduction of a substance to hold the two sheets of the pleura together and prevent recurrence of pleural effusion (pleuropexy).

The nature of the intervention depends on the nature of the effusion (fluid or air).
-    The pleural drain may be placed in the small of the back or on the upper front part of the chest.
-    A pleural drain can also be inserted in the axillary region.
Drains are always inserted under sterile conditions.
Local anaesthesia is administered at the chosen site after disinfection and cleaning of the area. A sterile field is applied to the zone in order to keep the area sterile. After local anaesthesia, an incision measuring 1-1.5 cm is made using a straight blade. A brief dissection leads to the pleura. A drain (a hollow, flexible tube some 20 cm long) is then introduced through the incision and down to the pleural cavity. After the drain has been introduced and free flow of the effusion verified, the incision is closed using sutures, preventing the drain from coming out spontaneously. A waiting thread is usually left in place in order to make final closure of the incision easier when the drain is removed. It is sometimes preferable to use clips rather than a waiting line. The drain is then connected to an anti-reflux valve system that empties the effusion but prevents air from entering the pleural cavity. This system can be connected to a source of suction in order to empty the pleural cavity more quickly. At the end of the procedure, a cotton wool dressing is applied to ensure that the drain is closed off and to protect the zone.

 

Technical details of the examination:

 

Preparation

After the procedure (pain prevention and management): a pleural drain is usually left in position for 2-4 days while the patient remains in hospital. If the drain is connected to its anti-reflux system, itself connected to an aspiration system, the patient’s mobility will be limited by the length of the pipes providing connection to the continuous aspiration system. The patient may experience difficulty with lying down on the drain location point. When drugs are introduced through the drain, pain prevention measures will be necessary.

Duration

The procedure lasts approximately ½ hour.

Contraindications

Stop taking anticoagulants in order to avoid excessive bleeding at the incision point.

Complications

- Coughing or pain may occur after the drain has been put in place.
- If the contents of the pleura are removed too quickly, vagal reactions (pallor, sweating, dizziness, reduced blood pressure or tachycardia) may occur.
- Pain may be felt in the drain insertion area during the hours or days that follow the insertion of the drain.
If complications occur: painkillers can be administered according to the patient’s needs. Atropine-type drugs can combat these vagal reactions.

 

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