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Intercostal chest drains: Are you confident going on the pull? If not use the I-T-U approach
A J Chadwick1, R Halfyard1, M Ali1
1John Radcliffe Hospital, Oxford University Hospital NHS Trust, Oxford, UK.
Insights
Chest drains are frequently used in intensive care units. This audit found variability in removal timing, prompting the development of the I-T-U assessment for safe and timely chest drain management.
Area of Science:
- Critical Care Medicine
- Thoracic Surgery
Background:
- Chest drains are essential in intensive care units (ICUs) for diverse clinical conditions.
- Current literature offers limited guidance on optimal chest drain removal timing in ICUs.
Purpose of the Study:
- To audit the variability in chest drain removal timing within an ICU setting.
- To develop a structured assessment tool for guiding chest drain removal decisions.
Main Methods:
- Retrospective audit of electronic patient records over one year.
- Assessment of chest drain duration against functionality (pleural space connection and fluid output).
Main Results:
- Chest drains had a mean duration of 5.89 days.
- A significant proportion (25%) of drains remained in place for three days despite being non-functional.
Conclusions:
- Significant variability exists in chest drain removal practices in ICUs.
- The developed three-stage I-T-U assessment aims to standardize and improve the safety and timeliness of chest drain removal.
Abstract:
Chest drains are common on intensive care units for a wide variety of clinical conditions. Despite this, there are no published data on their use within the intensive care unit and minimal published literature to guide decision making regarding the timing of their removal. Therefore, we undertook an audit to review our experience over one year, as to the degree of variability in when chest drains were removed. Using our electronic observation records, we assessed the length of stay of our chest drains against their functionality by whether they remained swinging (i.e. in connection with the pleural space) and whether they had a pathological fluid output (>150 mL/24 h). We found that our drains had a mean duration of 5.89 days, and that one-quarter remained in place for three days despite being non-functional. To conclude, we have devised a three-stage assessment (using the acronym I-T-U), to help guide an intensivist in the safe and timely removal of a chest drain.
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