Cuidados de enfermería para pacientes adultos con drenaje torácico: una revisión de alcance

Silva, Elisiane Goveia da; Araujo, Bárbara Rodrigues; Borges, Raphaela de Matos; Vieira, Tainara Wink; Paula, Cristiane Cardoso de; Caregnato, Rita Catalina Aquino

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Revista da Escola de Enfermagem da USP

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Sumário

REVIEW • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0017en copiar

Cuidados de enfermería para pacientes adultos con drenaje torácico: una revisión de alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

Mapear los cuidados de enfermería recomendados para pacientes adultos sometidos a drenaje torácico.

Método:

Revisión de alcance. Se incluyeron estudios en portugués, inglés y español, sin marco temporal, que respondieran a la pregunta de investigación: ¿qué cuidados de enfermería se recomiendan para pacientes adultos con drenaje torácico ingresados en cuidados intensivos? Selección en las bases de datos MEDLINE/PubMed, Embase/Elsevier, Web of Science/Clarivate, Scopus/Elsevier, CINAHL/Ebsco y LILACS/BVS. No se incluyeron datos de literatura gris.

Resultados:

De los 973 artículos identificados, se seleccionaron 21. Las precauciones citadas con más frecuencia incluían: llenar el frasco de recogida con agua destilada o solución fisiológica, dejando el extremo distal del vástago sumergido entre 1,5 y 2,5 centímetros; monitorización de las constantes vitales; tratamiento del dolor; y colocación adecuada del sistema. Hubo diferencias en la indicación de pinzar el sistema y ordeñar el sistema de drenaje/drenaje.

Conclusión:

Se mapearon 60 tareas de enfermería, 13 de las cuales se realizaron antes de la inserción del drenaje, nueve durante la inserción y 38 después de la inserción del drenaje torácico.

DESCRIPTORES
Atención de Enfermería; Tubos Torácicos; Unidades de Cuidados Intensivos

Database	Strategy
MEDLINE/PubMed	(Nursing Care[mh:noexp] OR Nursing[mh] OR Nursing, Team[mh] OR Nursing Staff, Hospital[mh] OR Nursing Service, Hospital[mh] OR Nursing Assessment[mh] OR Nursing Process[mh:noexp] OR Nurses[mh] OR Nursing[sh] OR Nursing[tiab] OR Nurse[tiab]) AND (Thoracostomy[mh] OR Thoracostom[tiab] OR Thoracic drain[tiab] OR Thorax drain[tiab] OR Chest drain[tiab] OR Pleural drain[tiab] OR ((Chest Tubes[mh] OR Chest Tube[tiab]) AND (Drainage[mh] OR Drain[tiab] OR Suction[mh] OR Suction[tiab])))
Embase/Elsevier	(‘nursing care’/exp OR ‘nursing’/exp OR ‘nursing staff’/exp OR ‘nurse’/exp OR Nursing:ti,ab,kw OR Nurse:ti,ab,kw) AND (‘thoracostomy’/exp OR ‘thorax drainage’/exp OR Thoracostom:ti,ab,kw OR ‘Thoracic drain’:ti,ab,kw OR ‘Thorax drain’:ti,ab,kw OR ‘Chest drain’:ti,ab,kw OR ‘Pleural drain’:ti,ab,kw OR ((‘chest tube’/exp OR ‘Chest Tube’:ti,ab,kw) AND (‘suction drain’/exp OR ‘drain’/de OR ‘suction’/de OR ‘suction drainage’/de OR Drain:ti,ab,kw OR Suction:ti,ab,kw))) AND ([embase]/lim NOT ([embase]/lim AND [medline]/lim))
Web of Science	TS=(Nursing OR Nurse) AND TS=(Thoracostom OR “Thoracic drain” OR “Thorax drain” OR “Chest drain” OR “Pleural drain”) OR (TS=”Chest Tube” AND TS=(Drain OR Suction))
Scopus	TITLE-ABS-KEY(Nursing OR Nurse) AND (TITLE-ABS-KEY(Thoracostom OR “Thoracic drain” OR “Thorax drain” OR “Chest drain” OR “Pleural drain”) OR (TITLE-ABS-KEY(“Chest Tube”) AND TITLE-ABS-KEY(Drain OR Suction)))
CINAHL	(MH (“Nursing Care” OR Nursing OR “Nursing, Team” OR “Nursing Staff, Hospital” OR “Nursing Service, Hospital” OR “Nursing Assessment” OR “Nursing Process” OR “Nurses”) OR TI (Nursing* OR Nurse) OR AB (Nursing OR Nurse) OR SU (Nursing OR Nurse)) AND* (((MH Chest Tubes OR TI “Chest Tube” OR AB “Chest Tube” OR SU “Chest Tube”) AND (MH (Drainage OR Suction) OR TI (Drain OR Suction) OR AB (Drain OR Suction) OR SU (Drain OR Suction))) OR MH thoracostomy OR TI (Thoracostom OR “Thoracic drain” OR “Thorax drain” OR “Chest drain” OR “Pleural drain”) OR AB (Thoracostom* OR “Thoracic drain” OR “Thorax drain” OR “Chest drain” OR “Pleural drain”) OR SU (Thoracostom* OR “Thoracic drain” OR “Thorax drain” OR “Chest drain” OR “Pleural drain”)))
BVS	(mh:(“Nursing Care” OR Nursing OR “Nursing, Team” OR “Nursing Staff, Hospital” OR “Nursing Service, Hospital” OR “Nursing Assessment” OR “Nursing Process” OR N02.360.650) OR ti:(Enfermage OR Nursing* OR Enfermeria* OR Enfermera* OR Enfermero* OR Enfermeir) OR ab:(Enfermage OR Nursing* OR Enfermeria* OR Enfermera* OR Enfermero* OR Enfermeir)) AND* (mh:(“Chest Tubes” OR Thoracostomy) OR ti:(“Chest Tubes” OR “Chest Tube” OR “Tubos toracicos” OR “Tubo toracico” OR Thoracostom* OR Toracostom) OR ab:(Thoracostom OR Toracostom) OR (tw:(Thorax OR Thoracic* OR Torax OR Toracic* OR Pleura* OR Chest) AND (tw:Drenage OR Drenaje* OR Dreno* OR Drain* OR Suction* OR Succao OR Succoes OR Succion*)))

Code	Study title	Year	Country of origin	Study objective	Design	Population
E1	Nursing management of chest drains: a systematic review (²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... )	2001	Australia	To present the best available research evidence on the nursing management of chest drains.	Systematic review	Eight randomized controlled trials.
E2	Chest drain removal in the postoperative period of cardiac surgery(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... )	2005	Brazil	To draw up a roadmap for the removal of chest drains by nurses in coronary and cardiac surgery units.	Literature review	There is no total number of studies included.
E3	To strip or not to strip? Physiological effects of chest tube manipulation(²³23. Halm MA. To strip or not to strip? Physiological effects of chest tube manipulation. Am J Crit Care. 2007;16(6):609–12. doi: http://doi.org/10.4037/ajcc2007.16.6.609.PubMed PMID: 17962505. https://doi.org/10.4037/ajcc2007.16.6.60... )	2007	United States of America	Summarize the scientific evidence on chest tube milking.	Literature review	Five original research studies, one systematic review, two exploratory descriptive studies.
E4	Nursing management of patients with a chest drain(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... )	2008	United Kingdom	To examine the role of nursing in the management of chest drainage, from insertion to removal, and to include aspects of pain control characteristic of a functional chest drain.	Literature review	Between 2000-2007, 15 articles; however, the authors increased the period to 1995-2007 and did not inform the total number of articles.
E5	The influence of the use of clamps on the accumulation of clots in tubular pleural drains(²⁵25. Lima AG, Rocha ERF, Seabra JCT, et al. The influence of clamp usage on clot deposit formation inside thoracic drains. Rev Col Bras Cir. 2008;35(2):79–82. doi: http://doi.org/10.1590/S0100-69912008000200003. https://doi.org/10.1590/S0100-6991200800... )	2008	Brazil	To assess the influence of the use of a cuff on the accumulation of clots inside pleural drains.	Prospective field study	53 patients (53 pleural tubes).
E6	The Effect of Cold Application in Combination with Standard Analgesic Administration on Pain and Anxiety during Chest Tube Removal: A Single-Blinded, Randomized, Double-Controlled Study(²⁶26. Demir Y, Kborsbid L. The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study. Pain Manag Nurs. 2010;11(3):186–96. doi: http://doi.org/10.1016/j.pmn.2009.09.002.PubMed PMID: 20728068. https://doi.org/10.1016/j.pmn.2009.09.00... )	2010	Türkiye	To investigate the effect of cold application on pain and anxiety during chest tube removal in patients undergoing cardiac surgery.	Single-blind randomized study	90 patients admitted to the cardiovascular and thoracic surgical ICU.
E7	Assistência de enfermagem na drenagem torácica: revisão de literature (Nursing care in chest drainage: a literature review)(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )	2011	Brazil	A literature review on nursing care in chest drainage.	Literature review	No total number of studies included.
E8	Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... )	2012	India	To analyze the prevalent practices in the care of the water-sealed thoracic drainage system according to the opinions of experts and against the available evidence.	Observational study	14 specialists.
E9	Chest tube care in critically ill patient: A comprehensive review(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... )	2015	Egypt	Know the risks associated with chest tube insertion. Describe how to prepare the chest drainage unit, carry out continuous patient assessments, properly document and solve possible problems related to the use of chest drains.	Literature review	There is no total number of studies included.
E10AD	Manipulação de drenos mediastinais e pleurais: existe evidência científica? (Manipulation of mediastinal and pleural drains: is there scientific evidence?)(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... )	2015	Brazil	To verify the existence of scientific evidence on the manipulation of pleural and mediastinal drains in cardiac surgery.	Systematic review	Six articles, including a review, a controlled clinical trial, a controlled experimental study and two descriptive studies.
E11	Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná(³¹31. Morais ACC, Lemos MM, Marques VD, Bandeira COP. Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná. Acta Sci [Internet]. 2016;38(2):173–7. doi: http://doi.org/10.4025/actascihealthsci.v38i2.26972. https://doi.org/10.4025/actascihealthsci... )	2016	Brazil	To evaluate the management of closed chest drainage systems by analyzing adult patients at the Regional University Hospital of Maringá, Paraná, to standardize the chest drainage care protocol and minimize complications.	Prospective observational study	We observed 100 chest drains from 83 patients.
E12AD	Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... )	2016	Sudan	To evaluate nurses’ knowledge and practice in relation to patients connected to chest drainage.	Quantitative descriptive study	50 nurses.
E13	Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... )	2018	China	To reveal the self-reported practice of managing chest drains by nurses and to define the decision makers for these practices.	Cross-sectional study	296 nurses.
E14	Intervenção de enfermagem: cuidados com dreno torácico em adultos no pós-operatório (Nursing intervention: chest tube care in post-operative adults)(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... )	2018	Brazil	Validate the nursing activities for the intervention established by the Nursing Interventions Classification “chest tube care”.	Content validation study	30 nurses specialists.
E15	Comparative Evaluation of Chest Tube Insertion Site Dressings: A Randomized Controlled Trial(³⁵35. Wood MD, Powers J, Rechter JL. Comparative evaluation of chest tube insertion site dressings: a randomized controlled trial. Am J Crit Care. 2019;28(6):415–23. doi: http://doi.org/10.4037/ajcc2019645.PubMed PMID: 31676515. https://doi.org/10.4037/ajcc2019645... )	2019	United States of America	To compare various types of dressings and procedures after the placement of thoracic and mediastinal drains.	Prospective randomized study	127 patients from three Intensive Care Units and 236 chest drains. Three groups were sampled, each with a different coverage and change frequency.
E16	Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )	2021	United States of America	Implement best practices to provide safe and effective care for patients with chest drainage systems in cardiothoracic wards.	Literature review	No number of studies included.
E17	Interdisciplinary teamwork for chest tube insertion and management: an integrative review(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... )	2021	France	To identify articles related to the interdisciplinary management of thoracotomy.	Integrative review	19 articles.
E18AD	Boas práticas de enfermagem na utilização de dreno de tórax: revisão integrativa (Good nursing practices in the use of chest drains: an integrative review)(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... )	2021	Brazil	To identify in the scientific literature the best nursing practices related to the use of chest drains in adult intensive care units.	Integrative review	Five articles, one quantitative and four quantitative.
E19AD	Chest drains: prevalence of insertion and ICU nurses’ knowledge of care(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... )	2021	Jordan	To describe the prevalence rate of chest tube insertion in Jordanian ICUs and to assess the level of knowledge of Jordanian nurses about chest tube care.	Descriptive non-experimental cross-sectional study	1973 files analyzed and questionnaire with 225 nurses.
E20AD	Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )	2021	Türkiye	To determine nurses’ level of knowledge about caring for patients with chest drains.	Descriptive study	152 nurses.
E21	Development and validation of the first performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )	2022	Germany	To validate an interdisciplinary performance assessment scale for chest tube insertion developed from an analysis of the literature.	Multicenter prospective study	40 videos of simulation sessions carried out by 80 participants.

N°	Pre-insertion TD recommendations	Code of studies
1	Double-check the patient’s identification.	E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
2	Inform the patient about the procedure and how they can help.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
3	Inform the family about appropriate care.	E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... )
4	Apply informed consent form.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
5	Check for allergies.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
6	Prepare the appropriate materials for inserting the TD: antiseptic solution (we suggest using alcoholic chlorhexidine solution because it is more cost-effective), sterile apron, mask and gloves, sterile drapes, sterile chest tube tray, local anesthetic, needles, syringes, scalpel with blade, curved kelly clamps, chest drain, drainage system, sharps waste, dressing material.	E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
7	Simple hand hygiene with antiseptic.	E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... )
8	Position the patient comfortably in bed: with the arm on the side where the drain will be inserted, placed behind the head so as to expose the armpit. The surgeon may ask for a pillow or blanket folded under the patient’s shoulder blades to elevate the chest and facilitate access.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
9	Fill the collection bottle with distilled water or saline solution, leaving the distal end of the stem submerged 1.5 to 2.5 centimeters.	E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E11(³¹31. Morais ACC, Lemos MM, Marques VD, Bandeira COP. Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná. Acta Sci [Internet]. 2016;38(2):173–7. doi: http://doi.org/10.4025/actascihealthsci.v38i2.26972. https://doi.org/10.4025/actascihealthsci... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
10	Fill the suction control chamber with water to a level of 20 centimeters of water (cmH2O).	E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... )
11	Administer analgesia as prescribed by the doctor.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )
12	Assist in the procedure by opening the packages with aseptic technique, providing standardized antiseptic.	E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E21(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... )
13	Record the volume of solution added to the collection bottle, as well as the date, time and name of the person responsible for the preparation.	E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E11(³¹31. Morais ACC, Lemos MM, Marques VD, Bandeira COP. Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná. Acta Sci [Internet]. 2016;38(2):173–7. doi: http://doi.org/10.4025/actascihealthsci.v38i2.26972. https://doi.org/10.4025/actascihealthsci... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
N°	Recommendations when inserting TD	Code of studies
14	Non-drug pain control techniques should be considered.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )
15	Reassure the patient and monitor signs of discomfort, assessing the need to administer a new dose of prescribed analgesia and informing the medical team.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
16	Support the patient during the procedure: advise them on the cold sensation of the germicidal solution and the sensation of pressure when infiltrating the local anesthetic.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
17	Observe the patient carefully throughout the procedure, monitoring respiratory function, peripheral oxygen saturation and any hemodynamic changes.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
18	Connect the drain to the previously filled collection bottle.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
19	The connection must be fixed in such a way as to maintain visibility.	E11(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )
20	Connect the drain to suction when indicated and check that the system is working properly.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )
21	The patient’s skin around the insertion must be inspected and cleaned with aseptic technique.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )
22	Perform occlusive dressing according to the institution’s routine.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
N°	Recommendations after inserting TD	Code of studies
23	Monitor vital signs every 2 hours, paying attention to breathing patterns, and assess and control pain using analgesics and non-drug techniques.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
24	Keep the drainage bottle in an upright position below the level of the patient’s chest.	E1(²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... ), E3(²³23. Halm MA. To strip or not to strip? Physiological effects of chest tube manipulation. Am J Crit Care. 2007;16(6):609–12. doi: http://doi.org/10.4037/ajcc2007.16.6.609.PubMed PMID: 17962505. https://doi.org/10.4037/ajcc2007.16.6.60... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E19AD(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
25	Assess and record the volume and appearance of the drains every 30 minutes to 1 hour for the first 3 to 4 hours after surgery.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... )
26	Inform the medical team immediately if there is a sudden increase in blood drainage volume (drainage greater than 100ml/h), except in the first 3 hours after surgery.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E8(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )
27	Keep the drainage tube free of kinks, avoiding the formation of a dependent loop; if this is unavoidable, lift the tube every 15 minutes.	E1(²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... ), E3(²³23. Halm MA. To strip or not to strip? Physiological effects of chest tube manipulation. Am J Crit Care. 2007;16(6):609–12. doi: http://doi.org/10.4037/ajcc2007.16.6.609.PubMed PMID: 17962505. https://doi.org/10.4037/ajcc2007.16.6.60... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E8(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... )
28	Observe for air infiltration around the tube insertion (subcutaneous emphysema).	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )
29	Observe for fluid oscillation along the length of the drainage tube, indicating that the system is working properly.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
30	Observe for bubbling, which should be slight, and notify the medical team if there is excessive or sudden bubbling.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E8(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E12AD(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
31	Clamp the drains whenever the drainage bottle is positioned above the level of the patient’s chest, ensuring that the clamp remains in place for as short a time as possible.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E19AD(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... )
N°	Recommendations when inserting TD	Code of studies
32	Do not clamp the drainage system even during patient transportation, just keep the system below the level of the patient’s chest.	E1(²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E12AD(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ),
33	Clamp the system by hand for as short a time as possible (less than 1 minute), only to change the water seal, or clamp it with tweezers if the system is accidentally disconnected.	E1(²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E5(²⁵25. Lima AG, Rocha ERF, Seabra JCT, et al. The influence of clamp usage on clot deposit formation inside thoracic drains. Rev Col Bras Cir. 2008;35(2):79–82. doi: http://doi.org/10.1590/S0100-69912008000200003. https://doi.org/10.1590/S0100-6991200800... ), E8(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ),E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E19AD(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )
34	Discourage the use of clamps.	E5(²⁵25. Lima AG, Rocha ERF, Seabra JCT, et al. The influence of clamp usage on clot deposit formation inside thoracic drains. Rev Col Bras Cir. 2008;35(2):79–82. doi: http://doi.org/10.1590/S0100-69912008000200003. https://doi.org/10.1590/S0100-6991200800... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E19AD(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... )
35	Change the water seal or drain bottle whenever there is a drain volume of more than 500 ml accumulated in the bottle.	E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... )
36	Check the drainage rate (it should not exceed 200 mL/h in the first two to six hours).	E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... )
37	Check drainage routinely (every 24 hours).	E9(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )
38	Make sure that the drain is connected to the correct inlet port on the collection bottle and, in the case of a suction drain, that the suction is turned on correctly.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E15(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
39	Replenish the amount of fluid in the water seal bottle whenever necessary, ensuring that the stem is submerged between 1.5 and 3.0 centimeters or, in the suction bottle, 20 centimeters, as this volume will determine the pressure being applied to the suction.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
40	Keep the vacuum pressure between 10 and 20 cmH2O.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )
41	Change the high-efficiency particulate air (HEPA) filter, indicated for patients in isolation due to the risk of aerosolization, such as SARS-CoV-2, per patient.	E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... )
42	Educate the patient and family about what will be done, the care of the drainage system and the correct position in which the system should be held.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
43	Encourage mobilization, coughing and deep breaths to facilitate drainage.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
44	Change the dressing at the insertion site once a day, making sure it is clean, dry and free of odor and/or signs of infection.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )
45	Dress with aseptic technique, using gauze and 0.9% saline solution.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... )
46	When available, use transparent film to apply the dressing, as this reduces the risk of infection and reduces the number of dressing changes, as the dressing can be kept on for three to seven days;	E17(³⁷37. Ghazali DA, Ilha-Schuelter P, Barbosa SS, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. doi: http://doi.org/10.5114/ait.2021.111349.PubMed PMID: 34870385. https://doi.org/10.5114/ait.2021.111349... ), E21(⁴⁰40. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs. 2021;77(4):2102–13. doi: http://doi.org/10.1111/jan.14743.PubMed PMID: 33543511. https://doi.org/10.1111/jan.14743... )
47	Apply a silicone-coated foam dressing with an adhesive border.	E15(³⁵35. Wood MD, Powers J, Rechter JL. Comparative evaluation of chest tube insertion site dressings: a randomized controlled trial. Am J Crit Care. 2019;28(6):415–23. doi: http://doi.org/10.4037/ajcc2019645.PubMed PMID: 31676515. https://doi.org/10.4037/ajcc2019645... )
48	Inspect the drain insertion site daily for signs of infection and proper positioning.	E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E16(³⁶36. Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid-Based Healthc. 2015;13(2):58–65. doi: http://doi.org/10.1097/XEB.0000000000000041.PubMed PMID: 26057649. https://doi.org/10.1097/XEB.000000000000... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )
49	Immediately cover the site with gauze and apply pressure to prevent negative inspiratory pressure from allowing air to enter the intrathoracic region if the chest tube is accidentally dislodged. Inform the doctor, organize material for reinserting the tube, reassure the patient and monitor them for signs of tension pneumothorax.	E12AD(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... )
50	Massage the drain, if obstructed, with your hand to try to remove the clot or fibrin.	E3(²³23. Halm MA. To strip or not to strip? Physiological effects of chest tube manipulation. Am J Crit Care. 2007;16(6):609–12. doi: http://doi.org/10.4037/ajcc2007.16.6.609.PubMed PMID: 17962505. https://doi.org/10.4037/ajcc2007.16.6.60... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... )
51	Discourage milking the drain.	E3(²³23. Halm MA. To strip or not to strip? Physiological effects of chest tube manipulation. Am J Crit Care. 2007;16(6):609–12. doi: http://doi.org/10.4037/ajcc2007.16.6.609.PubMed PMID: 17962505. https://doi.org/10.4037/ajcc2007.16.6.60... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E5(²⁵25. Lima AG, Rocha ERF, Seabra JCT, et al. The influence of clamp usage on clot deposit formation inside thoracic drains. Rev Col Bras Cir. 2008;35(2):79–82. doi: http://doi.org/10.1590/S0100-69912008000200003. https://doi.org/10.1590/S0100-6991200800... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... ), E10AD(³⁰30. Silva LDC, Brito LL. Mediastinal and pleural drains handling: is there scientific evidence? J Manag Prim Heal Care [Internet]. 2015;6(1):86–102. doi: http://doi.org/10.14295/jmphc.v6i1.236. https://doi.org/10.14295/jmphc.v6i1.236... ), E12AD(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... ), E13(³³33. Lu C, Jin YH, Gao W, Shi YX, Xia X, Sun WX, et al. Variation in nurse self-reported practice of managing chest tubes: A cross-sectional study. J Clin Nurs. 2018;27(5-6):1013–21. doi: http://doi.org/10.1111/jocn.14127.PubMed PMID: 29076204. https://doi.org/10.1111/jocn.14127... ), E19AD(³⁸38. Seyma ZK, Meral YC, Atiye E. Nurses’ Knowledge Levels About the Care of the Patients with Chest Tube. Int J Caring Sci. 2021 [cited 2023 Nov 21];14(2):1334–42. Available from: https://www.internationaljournalofcaringsciences.org/docs/58_zeyrek_original_14_2.pdf. https://www.internationaljournalofcaring... )
52	Perform milking when requested by the doctor or to prevent obstruction.	E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... ), E8(²⁸28. Rashmi TR. Analytical Study on Practices Related to Care of Water Sealed Chest Drainage System. Int J Nurs Stud. 2012 [cited 2023 Nov 21];4(2):177:182. Available from: https://ijone.org/scripts/IJONE%20JOURNAL.July-Dec%2012.pdf. https://ijone.org/scripts/IJONE%20JOURNA... ), E12AD(³²32. Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and Practice regard Care of Patient with Chest Drains in Sudan Heart Center, Khartoum, Sudan. IOSR-JNHS. 2016 [cited 2023 Nov 21], 5(6):1–6. Available from: https://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue6/Version-4/A0506040106.pdf. https://www.iosrjournals.org/iosr-jnhs/p... ),E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... )
53	Monitor for signs of resolution of pneumothorax, hemothorax, among others; by observing the volume and appearance of the drains.	E14(³⁴34. Almeida RC, Souza PA, Santana RF, Luna AA. Nursing intervention: post-operative care with chest tube in adults. Rev Rene. 2018;19:e3332. doi: http://doi.org/10.15253/2175-6783.2018193332. https://doi.org/10.15253/2175-6783.20181... ), E18AD(¹⁰10. Hasselmann BNO, Ranção CS, Tavares GS, Almeida LF, Camerini FG, Paula VG. Good practices in nursing in the use of chest tubes: an integrative review. Glob Acad Nurs [Internet]. 2021;2(2):e173. doi: http://doi.org/10.5935/2675-5602.20200173. https://doi.org/10.5935/2675-5602.202001... ), E20AD(³⁹39. Ghazali DA, Ilha-Schuelter P, Barreyre L, Stephan O, Barbosa SS, Oriot D, et al. Development and validation of the frst performance assessment scale for interdisciplinary chest tube insertion: a prospective multicenter study. Eur J Trauma Emerg Surg. 2022;48(5):4069–78. doi: http://doi.org/10.1007/s00068-022-01928-9.PubMed PMID: 35376968. https://doi.org/10.1007/s00068-022-01928... )
54	Apply a cold compress 20 minutes before removing the chest tube to reduce the intensity of the pain associated with removing the tube.	E6(²⁶26. Demir Y, Kborsbid L. The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study. Pain Manag Nurs. 2010;11(3):186–96. doi: http://doi.org/10.1016/j.pmn.2009.09.002.PubMed PMID: 20728068. https://doi.org/10.1016/j.pmn.2009.09.00... )
55	Administer analgesia, as prescribed by the doctor, at least 30 minutes before removing the drain.	E1(²¹21. Charnock Y, Evans D. Nursing management of chest drains: a systematic review. Aust Crit Care. 2001;14(4):156–60. doi: http://doi.org/10.1016/S1036-7314(05)80058-X.PubMed PMID: 11806513. https://doi.org/10.1016/S1036-7314(05)80... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E6(²⁶26. Demir Y, Kborsbid L. The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study. Pain Manag Nurs. 2010;11(3):186–96. doi: http://doi.org/10.1016/j.pmn.2009.09.002.PubMed PMID: 20728068. https://doi.org/10.1016/j.pmn.2009.09.00... )
56	Instruct the patient on how to remove the chest tube and perform the Valsalva maneuver, as well as the procedure that will be carried out.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E9(²⁹29. Mohammed HM. Chest tube care in critically ill patient: a comprehensive review. Egypt J Chest Dis Tuberc. 2015;64(4):849–55. doi: http://doi.org/10.1016/j.ejcdt.2015.06.002. https://doi.org/10.1016/j.ejcdt.2015.06.... )
57	Prepare material for removing the drain and dressing.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... ), E7(²⁷27. Lúcio VV, Araújo APS. Nursing Care in Thoracic Drainage: a Literature Review. UNOPAR Cient Ciênc Biol Saúde. 2011 ; [cited 2023 Nov 21];13:307–14. Available from: https://journalhealthscience.pgsskroton.com.br/article/download/1079/1034. https://journalhealthscience.pgsskroton.... )
58	Position the patient in a supine position with the arm raised above the head.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... )
59	Apply an occlusive dressing after removing the drain.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... )
60	Monitor the wound site for signs of infection and remove the stitches seven days after removing the drain.	E2(²²22. Parra AV, Amorim RC, Wigman SE, Baccaria LM. Withdrawal of thorax drain in postoperative of cardiac surgery. Arq Ciênc Saúde [Internet]. 2005 [cited 2023 Nov 21];12(2):116–119. Available from: https://repositorio-racs.famerp.br/racs_ol/Vol-12-2/10.pdf. https://repositorio-racs.famerp.br/racs_... ), E4(²⁴24. Sullivan B. Nursing management of patients with a chest drain. Br J Nurs. 2008;17(6):388–93. doi: http://doi.org/10.12968/bjon.2008.17.6.28906.PubMed PMID: 18414310. https://doi.org/10.12968/bjon.2008.17.6.... )

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[1] Corresponding author: Elisiane Goveia da Silva, Rua Sarmento Leite, 245, Centro, 90050-170 – Porto Alegre, RS, Brazil, e-mail: elisiane.silva@ufcspa.edu.br