2 Current practice

2 Current practice

Conventional chest drains use an underwater seal to help drain air and fluid from the pleural space, allowing the lung to re-inflate. This can be done with or without additional wall suction. The NICE guideline on major trauma recommends chest drains for managing chest trauma in pre-hospital and hospital settings, but chest drain management is not specifically covered by NICE guidance.

The British Thoracic Society guidelines on pleural disease state that chest drains should include a valve mechanism to prevent fluid or air entering the pleural cavity. This may be an underwater seal, flutter valve or other recognised mechanism. Chest drains with underwater seals appear to be standard care in the NHS and consist of a water seal, optional suction control and drainage collection bottle. These drains collect fluid and prevent backflow into the pleural cavity, while at the same time allowing a subjective assessment of air leaks and fluid loss. The drainage bottle must be placed below chest level and kept upright. Suction may sometimes be needed, depending on the patient's condition, and can usually be provided using a low grade wall suction unit.


This page was last updated: 12 March 2019