[Use pleural drainage optimally! Current systems are quick and easy to manage]

Recent years have witnessed improvements in pleural drainage systems, especially in terms of emitted noise levels. Pleural drainage can now be performed without noise disturbance in the ward. It is recommended that a drainage system containing a water column manometer be used, to enable intrapleural pressure and pressure fluctuations to be monitored. Presence of increased fluctuation allows pneumothorax to be suspected, but a slight fluctuation is indicative of normal function of the drain. When active suction is terminated, the level of negative pressure obtained in the unit is preserved. Gradual dissipation of this negative pressure is indicative of a small continuing air leak from the patient, whereas preservation of the negative pressure level for several hours indicates the absence of such leakage (thus possibly obviating the need of a further x-ray before removal of chest tubes). The presence of an underwater seal is recommended, although there are systems that work without water. The systems may be used without active suction, e.g. for gravity drainage of fluid after pneumonectomy, and may temporarily function as portable Heimlich valves.