Nursing management of chest drains: a systematic review

The aim of this systematic review was to summarise the best available evidence relating to the nursing management of chest drains. Studies included were those involving hospital patients with a chest drain in situ. A comprehensive and systematic search of the literature was undertaken that included all major databases. Methodological quality was assessed using a developed checklist. The randomised controlled trial (RCT) design was rarely used and therefore evidence was summarised using a narrative discussion. Studies using other methods were also assessed for inclusion in this narrative summary. The findings of this review highlight the lack of research on most aspects of the nursing management of patients with chest drains in situ. RCTs suggest that chest drains remain patent with or without stripping and milking of tubes, but that the total drainage was greater from manipulated tubes. There is little evidence relating to other aspects of chest drain management such as dressing of insertion site, actions following accidental disconnection and tube removal. There is therefore a need for rigorous research in many areas of the nursing management of chest drains, particularly with subjects under the age of 18 years.