Sometimes fluid or air buildup can occur in the lungs, affecting breathing and heart function. In these cases, health is at risk and a pleural drain must be placed to relieve pressure on the lungs.
What is pleural drainage?
Drains are basically to remove air or fluid collections from the body through a tube into a container that collects the fluid. Drains are basically meant to drain air or fluid collections out of the body via a tube into a container that collects the fluid. It is often placed after surgery to drain out wound fluid and keep the risk of infection in the wound area low. A pleural drain directs air or fluid from the lungs out of the chest to relieve pressure on the lungs and make breathing easier. Due to a variety of circumstances, air and fluid buildup can occur in the lungs, acutely threatening health. In these cases, a tube is inserted into the pleural space between the pleura and the lung pleura to relieve pressure on the lung. Pleural drainage is also called chest drainage.
Function, effect, and goals
Pleural or thoracic drainage becomes necessary whenever air, blood, or pus accumulates in the pleural space and the lungs do not have enough room to expand, causing severe shortness of breath. When fluid accumulates there, the arteries and veins leading to the heart also can no longer supply the heart with sufficient blood. The accumulation of fluid or air creates pressure in the lungs that can be life-threatening, but can be relieved by pleural drainage. Some medical conditions necessitate a chest drain, such as pneumothorax and tension pneumothorax. Air can enter the pleural space through an injury to the ribs or by opening the chest during surgery, causing symptoms such as pain, shortness of breath and heart palpitations. If air enters the pleural space during inhalation but cannot be exhaled normally, a life-threatening situation occurs because the pressure may increase to the point that the heart is unable to perform its full function. In hemothorax, blood may accumulate in the lungs due to injury to the blood vessels. If this situation persists for a long period of time, there is not only pain and shortness of breath, but also blood loss. In this life-threatening situation, pleural drainage can be a life-saving measure. In particularly severe cases, surgery is often required beyond placement of the drain. In pleural empyema, there is an accumulation of pus in the pleural space, in most cases due to infections in the chest area from pneumonia or surgery. In this case, in addition to draining the pus, it is necessary to flush the chest with a saline solution. There are different procedures in a chest drainage. The most common are the Monaldi drain, which is used primarily for air collections, and the Bülau drain, which is used for fluid collections. Drainage systems may differ in the number of collection containers, among other factors. A pleural drain must be placed in a sterile manner. After disinfecting the skin, the ribs are palpated and a puncture site is marked in the middle of the back. An incision of about 1 cm is made there, through which the drain is inserted.
Risks, side effects and dangers
Pleural or thoracic drainage is one of the most important life-saving procedures, but it is not without risks. Although serious complications rarely occur, the lung may be injured during the procedure and pneumothorax may occur as a complication. In order to position the tube correctly, it is necessary to open the pleural space and the rib muscles at the right place in the back. There is an artery and nerve at the bottom of each rib that can be injured by this procedure, especially if it must be done under time pressure due to a life-threatening condition. Such an injury may result in bleeding and, in more difficult cases, may also result in insensations such as numbness if a nerve has been injured in the process. The risk of injuring body tissue in the adjacent area by placing the drainage cannot be ruled out either.If this results in injury to the heart, trachea or aorta, life-threatening complications may occur. If pleural drainage is not possible without discomfort, doctors choose emergency surgery in most cases. The wound itself, created by placing the drain, is also a risk because pathogens can collect there and cause infection. A doctor should always be consulted if there is redness, swelling at the puncture site, shortness of breath or palpitations, as well as if large amounts of fluid are secreted, because this may indicate further bleeding. However, if a life-threatening situation is present, the advantages outweigh the disadvantages. When placing a chest tube, the patient must be careful not to apply traction to the tube so that it does not slip out before removal. Pain may occur when the tube is pulled, but this can be eliminated by administering a local anesthetic. Hygienic conditions play an important role in avoiding unnecessary risks. To keep the risk of infection low, the procedure must be performed under sterile conditions.
