Pleural drain

A pleural drain is used to evacuate liquid or air contents from the pleural cavity when other simpler measures, such as exsufflation or pleural puncture, do not provide a satisfactory result. A pleural drain can also be placed after a pleuroscopy, or to allow for the introduction of a substance intended to join the two layers of the pleura together and prevent the recurrence of a pleural effusion (talcation).

The procedure takes about half an hour.

The nature of the procedure depends on the nature of the effusion (liquid or air).

The pleural drain can be placed on the back in a low position or on the front of the chest in a high position. The drain can also be placed in the axillary region. The placement of a drain is always done under sterile conditions.

A local anesthesia is performed in the chosen area after disinfection and cleaning of the area. A sterile field is applied on the area to ensure sterile conditions. An incision of about 1 to 1.5 cm is made with a scalpel blade after local anesthesia. A short dissection allows reaching the pleura. A drain (a hollow, flexible tube about 20 cm long) is then introduced through the incision into the pleural cavity. After inserting the drain and checking that the effusion is draining properly, the incision is closed with sutures to prevent the drain from coming out spontaneously. To facilitate final closure of the incision when the drain is removed, a holding suture is usually left in place. In some cases, staples may be used instead of a holding wire. The drain is then connected to an anti-reflux valve system which allows for the effusion to drain outwards but prevents air from entering the pleural cavity. This system can be connected to a suction source to accelerate the emptying of the pleural cavity. At the end of the procedure, a padded bandage is applied to prevent the drain from bending and to protect the area.

A pleural drain is usually left in place for 2 to 4 days during a hospitalization. If the drain is connected to its anti-reflux system, which is itself connected to a suction system, the patient's mobility is limited by the length of the tubes connected to the continuous suction system. The patient may have difficulty lying on the location where the drain is placed. If medication is introduced through the drain, pain prevention measures are necessary.

Coughing or pain may occur after the drain is placed.

If the contents of the pleura are evacuated too quickly, vagal reactions (pallor, sweating, dizziness, drop in blood pressure, and tachycardia) may occur. Pain in the drain insertion area may also occur in the hours or days following the placement of the drain.

Painkillers can be administered according to the patient's needs in the case of complications. Atropine drugs can help counteract vagal reactions.

Anticoagulant drugs should be stopped to avoid excessive bleeding at the incision site.