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