Chest Drains - ambulatory

When would they be used?

All children who require a pleural drain for > 2 days post operation who are of walking age should be swapped to the Mini Atrium Express (ambulatory) drains (i.e. ALL Fontan patients, complex tetralogy patients and some other groups as identified by the surgical team).

Routine practice: change to the Mini Atrium Express (ambulatory) drain on day 2 post-op (23b and PICU) if; no bubbling and < 100mls drainage in previous 24 hours.

These drains are lighter and make mobilisation easier - this improves patient ventilation and morale and reduces the risks of post-operative chest infections. In the Fontan group, increased ventilation helps to promote pulmonary blood flow and it is probable that this may reduce the duration of pleural losses.

What is different about these drains?

• They have a one way valve so they do not use a water seal

• Set up involves connecting the tubing and drain - one step (see Set up instructions for Atrium Mini Express (Ambulatory Drains))

• The drains should be lower than the chest ideally but it is not essential at all times like it is for underwater seal drains

• They are small and hang from the bed or can be attached to the child using velcro straps to make it easy for patients to mobilise.

• When they are full they can be emptied using a leur lock syringe (see attached document for more information)

Ward leave with an ambulatory drain

Some patients who are medically well other than their pleural losses, may be able to leave the ward with an ambulatory drain in situ in the care of their caregivers. This will depend on an assessment that the child and caregivers are able to maintain the safety of the child and will involve education and preparation of the caregivers by the nursing staff.

Process for ward leave with an ambulatory drain:

• Consultant agrees and documents that the child is safe to mobilise off the ward.

• Accompanying parent/carer have received education and demonstrated competence with:

  • Safety and connection checks

  • What to do if the connections become disconnected

  • What to do if the drain comes out partially

  • What to do if the drain comes out completely

  • What clinical signs to monitor for and when to seek medical review

• Patient has emergency kit with them - including ward numbers

  • Numbers to call

  • Emergency card

  • Gloves

  • Scissors

  • Tape to secure dressings

  • Gauze squares

  • Comfeel/air tight dressing

  • Chest drain clamps

• Accompanying parent/carer has had CPR training

• Accompanying parent/carer has access to a phone or cell phone at all times.

Set up Atrium Mini Express (Ambulatory Drains) instructions