Cuidados com o sistema de drenagem torácica em adultos internados no Hospital Universitário Regional de Maringá, Estado do Paraná, Brasil

Abstract

RESUMO. Avaliou-se, prospectivamente, o manejo dos sistemas de drenagem torácica fechada em pacientes adultos no Hospital Universitário de Maringá, Estado do Paraná, no período de dez meses. Foram acompanhadas 90 drenagens em 75 pacientes. Predominou a causa traumática em pacientes jovens como determinante de indicação da drenagem pleural (61/90, 68%). A falta do curativo em meso e contrameso, como fixação complementar do dreno, foi a ocorrência isolada mais comum no manejo, sendo encontrado rotineiramente em 20% (18/90). A presença de obstrução (por dobramento, sifonagem, coágulo ou fibrina) esteve presente em 12% das drenagens (11/90) e complicações (enfisema subcutâneo, infecção, deslocamento acidental, pneumotórax na retirada do dreno) em 21% (20/90). O manejo apropriado da drenagem torácica reduz a morbidade associada ao método. Esta pesquisa ressalta a importância do treinamento continuado e do estabelecimento de manuais que padronizem condutas para os profissionais da saúde que manejam o sistema de drenagem torácica.Palavras-chave: drenagem, tubos torácicos, toracostomia, cavidade pleural, cirurgia torácica.ABSTRACT. Care with the thoracic drainage system in adults at the Universitary Hospital of Maringá, Paraná State, Brazil. The handling of adults' closed thoracic drainage systems at the University Hospital of Maringá, Maringá, Paraná State, Brazil during a 10-month period was prospectively evaluated. Ninety thoracic drainages in 75 patients were analyzed. Traumatic causes in young patients determined pleural drainage (61/90, 68%). The absence of an omental tag of tape as a complementary tube fixation was the most common, albeit isolated case, occurrence in the procedure. In fact, it has been routinely found in 20% (18/90) of cases. Whereas tube obstruction (due to kinking, siphoning, clotting or fibrin) was detected in 12% (11/90) of drainage cases, drainage complications (subcutaneous emphysema, infection, accidental dislodgement, pneumothorax following chest tube removal) occurred in 21% (20/90) of cases. Adequate handling of tube thoracostomy reduces morbidity related to this procedure. Current research enhances the importance of continuous training and of textbooks that would standardize procedures for health teams whose role involves interventions in the thoracic drainage system.

Profile of thoracic trauma victims submitted to chest drainage

“…Some studies show that drains inserted in the Emergency Room are more likely to require drainage repositioning and, therefore, the chances of infection increase. Some authors claim that drainage by residents has a greater chance of technical failures, with a higher rate of complications 6,16,17 .…”

Practical Aspects About Closed Chest Drainage Care: A Literature Review

“…The chest drainage also aims to maintain or restore the negative pressure of the pleural space [2][3][4]12,16,18,20 . For each case, there are 3 types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system [7][8][9][10][11][12][13][14][15][16][17][18][20][21][22] .…”

“…Properly managing the drainage system minimizes procedure-related complications 7,8 . Therefore, strategic educational initiatives are in place to ensure knowledge deficits are focus on a chest drain management.8, A greater awareness of the areas of knowledge weakness regarding chest drain management will facilitate targeted educational initiatives in the future, ensuring improved chest drain management 9 .…”

<b>Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná

“…The pleural space is inspected with the index finger and the drain moved forward in the appropriated position, apico-posterior, anchoring it with a skin suture, usually a 'U' stitch with Roman sandal suture pattern. It is recommended that a chest X-ray examination be always made immediately after inserting the drain, so that its position and lung re-expansion may be observed (Nishida, Sarrão, Colferai, Tenório, & Bandeira, 2011).…”

“…Among the main failures that may take place in chest drainage are: obstruction of the tube (due to clots or fibrin, inappropriate clamping, kinking caused by excessive length of the extension tube), inappropriate positioning, fixation, and connection of the drain, inappropriate height of the water seal, improper positioning of the collection bottle, obstruction of the air vent, negligence when checking oscillation of the water seal (Nishida et al, 2011).…”