Modified Urinary Collecting Bags for Prolonged Underwater Chest Drainage Yaron Bar-El, MD, Yair Lieberman, MD, and Alon Yellin, MD Departments of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
We describe a method by which a modified urinary collecting bag is used as part of a chest drainage system. This system is especially suitable for patients who require prolonged periods of drainage. (Ann Tkorac Suyg 1992;54:995-6)
atients who require pleural drainage after thoracic operations or for air leak, persistent effusion, or empyema are usually managed by a pleural tube connected to an underwater sealed collecting device. This arrangement is quite cumbersome for the patient who needs prolonged pleural drainage and who is ambulated and free to walk. We propose an effective and inexpensive yet simple, convenient, and lightweight drainage system for such patients.
outpatients. There were no complications related to the technique.
Comment A catheter or tube is usually left in the pleural space after open and closed thoracotomy procedures to drain fluid and air, and to allow the lung to expand. To prevent air and fluid reflux, either a molded plastic apparatus with a water seal or a one-way flutter valve (Heimlich valve) is used [l].These two commonly used methods have their shortcomings. The underwater sealed apparatus is usually cumbersome, heavy, and inconvenient, especially for the ambulated patient who may require a longer period of
Method A simple polyethylene urine collecting bag is used. The bag is modified in such a way that a water seal is created within the bag. This is achieved by soldering the bag (with a soldering device used for closing polyethylene bags) so that an inflow tunnel is created, draining into the lower part of the bag, which contains a small amount of water (Fig 1).The tunnel is seen between the two vertical lines. During deep inspiration, the two sides of the bag in the central tunnel tend to adhere to each other, thus serving as a flutter valve further preventing reflux into the chest tube. When there is excessive air leak, a small hole is made in the upper part of the bag, allowing the air to escape. Use of this bag, especially if attached to the patient’s garments, allows convenient mobilization and free use of the hands (Fig 2). The inexpensive bag is replaced daily. We have used this drainage method on 6 patients with empyema (2 postoperative, 1 traumatic, 3 parapneumonic), 2 with bronchopleural fistula, 1 with prolonged air leak after segmentectomy, and 3 elderly patients with pneumothorax associated with emphysema. The system was used for 7 to 30 days (mean, 18 days). All but 2 patients were discharged and continued treatment as Accepted for publication July 27, 1992. Address reprint requests to Dr Yellin, Department of Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
0 1992 by
The Society of Thoracic Surgeons
Fig 1 . The modified urinary collecting bags. Note the two soldering lines beginning at the top of the bag and continuing almost to the bottom.
HOW TO DO IT BAR-ELET AL MODIFIED COLLECTING BAGS
Ann Thorac Surg 1992;549956
pleural drainage. The rigid apparatus usually needs some support mechanism to remain in the upright position. The Heimlich flutter valve, on the other hand, is light and convenient, but blood or other thick pleural fluids that pass between its two rubber leaves may cause them to adhere to each other, thus obstructing the lumen and preventing further drainage. Our proposed system overcomes the disadvantages of both methods. The lightweight bag is convenient for use and can be carried either on or under the garments. During sleep it can be attached to the bed. The walls of the bag, in a fashion similar to the Heimlich device, act as a flutter valve but are less liable to cling to each other, thereby allowing the bag to remain patent. In addition, this system is obviously cost-saving, requiring only inexpensive urinary collecting bags modified with a simple soldering device. Because active suction (negative pressure) cannot be applied to the bag, its use is not recommended in the immediate postoperative period. However, we do find it applicable for those patients who require prolonged pleural drainage, and especially for those who are ambulatory or can be discharged from the hospital. Although not yet tested, this system might also be suitable in emergency situations (eg, military, trauma) when immediate intrapleural drainage is required.
Reference Fig 2. The collecting system in use.
1. Heimlich HJ. Valve drainage of the pleural cavity. Dis Chest 1968;53:282-7.