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Chest drain removal protocol in PICU - EXACT Pathway

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This guideline covers chest drain removal in post cardiac surgical patients admitted to PICU. It ONLY applies to patients who are extubated on the EXACT 2 hour pathway.

The aim is to have the chest drains removed prior to the 0800 cardiac ward round to expedite patient discharge to ward 23B.


  • All Neonates (<28 days)
  • All single ventricle surgery - Norwood, BDG, and Fontan patients
  • All tetralogy patients
  • Any patient with an open chest
  • Any complex surgery
  • Any patient with an aortic cross clamp time > 120 minutes
  • Any bubbling from the drain(s)

Other patients may be suitable for early chest drain removal after discussion with the surgeon involved.

Criteria for Drain Removal

  • No bubbling
  • Drainage < 2ml / kg over 6 hours


Mobilise patient in age appropriate way before drain removal to ensure no residual collection.

Age < 1 year

  • Do not cease feeding
  • Give bolus of morphine (20mcg / kg) if required and remove drains.

Age > 1 year

  • Cease feeds if giving Ketamine - 6 hours food/formula. 2 hours clear fluid.
  • <10 years       Ketamine 0.5mg / kg IV
  • 10 years+       Fentanyl 0.5mcg / kg IV

Post Drain Removal

  • Obtain chest xray within 30-60 mins of drain removal
  • Review chest xray prior to ward discharge

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Document Control

  • Date last published: 06 June 2018
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: Dave Buckley
  • Editor: John Beca