Chest Drainage

[MM2007]

Hi,

Could anyone tell me if there is a specific limit to how much pleural fluid is able to be drained off a patient post chest drain insertion. Since in the little experience i have, i know that if to much fluid is drained the patient becomes hypotensive, is this due to fluid shift ??.

I would be really grateful for any help and references.

Thankyou.

[Antikigirl, ASN, RN]

Tricky one, but with our chest tubes we have no set limit unless the MD's say so. One, because there could be a large area in need of drainage that they can't quite measure accurately and Two, the irritation of the tube and the underlying probelm can be causing continuous fluid build-up and basically the chest tube is just 'keeping up' with the output.

I tend to rely on trends! I mark my areas on the container with hour and a line every two hours and see the trend. If too much is draining..that is a call to the MD to notify them that it is increasing. Or all the sudden it stops...I call too. That is a change in condition and worthy of a call!

Oh and yes..this is a fluid compartment switch..and one must keep an eye on blood lab values to ensure hemostasis...just like in any case of fluid shifts like in edema of any area.

Basically your facility will have policies according to product used, so check that out to educate yourself. Also, when in doubt I ask other nurses, or even the MD themselves! MD's can be a fun reference really...and this is a great question for them to show off their knowledge if you present it in a way that shows you are very interested in this! My docs always shared that type of info to me!

Great question

[Corey Narry, MSN, RN, NP]

Hi,

Could anyone tell me if there is a specific limit to how much pleural fluid is able to be drained off a patient post chest drain insertion. Since in the little experience i have, i know that if to much fluid is drained the patient becomes hypotensive, is this due to fluid shift ??.

I would be really grateful for any help and references.

Thankyou.

When it is anticipated that large amounts of pleural fluid will drain out of a freshly inserted chest tube, it is always prudent to limit the initial drainage to 1-1.5 L to prevent re-expansion pulmonary edema which can be a life-threatening complication of chest tube insertion.

Usually, the physician/NP/PA will stop fluid drainage by clamping the chest tube and wait 2 to 4 hours before draining further fluid if the patient develops chest pain, shortness of breath, or oxygen desaturation.

Hypotension will usually not occur because the fluid being drained is not in the intravascular space.