Four RCTs (n=469) that addressed review questions about chest drain tubing, and one RCT (n=24) that addressed a review question about removal of the chest drain, were included. Ultimately, indirect evidence from RCTs and other study designs also contributed to the results.
Dressings.
No RCTs were found that addressed the question of what type of dressing should be used around the insertion site, or how often they should be changed. Only discussion papers were retrieved.
Chest drain tubing.
Four RCTs (n=469) compared milking with stripping. One trial in adult men undergoing coronary artery bypass (n=49) indicated that chest tubes remained patent with or without milking or stripping, and showed no significant difference in total drainage volume, heart rate or arrhythmias. A trial in adults who had undergone myocardial revascularisation (n=200) showed no statistically-significant difference in cardiac tamponade or surgical re-entry, and no clinically significant difference in total drainage or the number of manipulation episodes. A trial in adult cardiac surgical patients (n=204) showed no significant difference in mediastinal or thoracic output. A small trial in paediatric (3 to 21 years) oncology patients (n=16) showed no significant difference in the frequency of pain, incidence of fever, breath sounds or radiographic findings between patients whose tubes were not stripped and those whose tubes were stripped. No RCTs were found that specifically addressed the effect of chest tube position on drainage.
Chest drain bottle or unit.
No RCTs were found that specifically investigated how often the chest drainage bottle or unit should be changed to minimise the risk of complications. No research evidence was found to inform the optimal position of the bottle to facilitate drainage.
Disconnection.
No RCTs were found that addressed whether tubing should be clamped after disconnection of the drainage bottle, or when moving a patient.
Removal of chest drain.
No RCTs were found that investigated the optimal patient position during removal of the drain. One small trial in aorta-coronary bypass surgery patients (n=24) investigated the optimal breathing pattern during removal to promote patient comfort. No significant difference in pain, measured on a visual analogue scale, was shown between the Quick Relaxation Technique plus analgesia versus analgesia alone.