The dangers lurking in outdated chest drain solutions

Even though conventional underwater seal drains are widely used, they may provide a variety of potential risk factors for healthcare professionals and patients. Several mistakes can happen as the drainage management belongs to one of many different tasks during day-to-day work, which moreover needs special attention. A variety of handling mistakes can appear, starting from setting up the drain, during usage or when checking the patient´s progress. The challenges regarding drainage management are different for nurses and surgeons. While nurses pay attention on an appropriate handling during and after surgery, surgeons are especially focused on a proper and efficient decision about treatment options. Both benefit from different advantages when using Thopaz+ as the method of choice, as well as finally patients do. In the following articles you can read about the risks in chest tube management with underwater seal drains and how the use of the digital chest drainage system Thopaz+ prevents these risks out of the perspective of a nurse, a surgeon and finally out of the perspective of a patient as the one who experiences the drainage at first hand.

The perspective of a nurse

Although they are widespread, conventional underwater seal drains may pose significant risks to healthcare workers and patients. Mistakes can happen during setup, in use and when checking the patient's progress. The challenges for a nurse about drainage management are various as they are responsible for the appropriate handling during surgery as well as post-operative. A nurse benefits from different advantages when using Thopaz+ as the method of choice.

Mistakes can occur in a hectic environment such as the ICU. When the patient arrives, a conventional underwater seal drain needs to be attached quickly. And to the right wall vacuum source. Sometimes it may happen, that a high-vacuum source is attached accidentally. Additionally, the vacuum source must be attached to the right port of a chest drain. New nurses may be overwhelmed with the amount of connections possible on underwater seal drains and due to the rare incident of having a chest drain patient so that they attach suction to the wrong port.

When the patient arrives, the chest drain unit must be placed below the patient's chest to ensure proper functioning. As these plastic boxes are placed on the floor next to the patient, it is commonplace that they are knocked over. This may have an impact on the function or on the calculation of the fluid drained. Depending on the underwater seal drain use, a priming of the water seal chamber is necessary. This needs to be done before the patient is attached. Also, this level needs to be checked on a frequent basis, to make sure the water seal function stays upright and working. Chest drain units with water vacuum gauges need to be checked on the water level to ensure the pressure arriving at the patient. Often nursing staff thinks that the pressure set on the wall vacuum source and prescribed by the surgeons is the pressure the patient gets. However, this is not always the case. Publications reveal that the pressure the patient actually gets is dependent on various factors, such as:

- The elevation of the device relative to the patient1,2

- The amount of fluid in the tube1

- Uncontrolled siphoning effects within the chest tube2

- A column of fluid advancing downward along the chest tube may increase resistance and in turn, increase the pleural pressure.3

And finally, during use, it is vital to regularly check the underwater seal drain to make sure there are no leaks in the system, no disconnections or an excess of fluid collected. These factors must be recognized when handling conventional underwater seal drains.

All these considerations led to the development of Thopaz+

  • With its integrated long-life battery and suction source, Thopaz+ does not require attachment to an external suction source. There is no possibility to mistaking the right source.
  • No matter where the pump is placed the regulated pressure arrives close to the patient. Thus, there is no need for a device to be under patient level. Various holders for the device are available for simple and safe attachment to IV poles or hospital beds.
  • Canister and tubing are clicked in – simple and easy to set up.
  • Any leaks in the system, disconnections or excess of fluid collected are automatically detected by Thopaz+ and alarms and notifications are given if intervention is required.
  • Siphoning in tubing can still occur when Thopaz+ is used. However, the device easily compensates for this and uses air to flush the tubing periodically to remove any fluid remaining in the tubing.
  • The pressure set on the device is the pressure that arrives at the end of Thopaz+ tubing. Thopaz+ has a dual lumen tubing that serves to monitor the pressure arriving at the patient and adjusting the pressure to the selected value.
  • Easier mobilization of patient, just pick up the pump and go.

Nurses | The dangers lurking in outdated chest drain solutions
Learn more about the benefits of working with a digital chest drainage system and why nurses prefer using Thopaz+ over underwater seal drains.

Click here to read more on the patient's perspective or see below the surgeon's perspective.

The perspective of a surgeon

During chest drainage the patient's progress must be monitored. Often this is done on an hourly basis or over a period by recording air leak and drained fluid. But even so, this is only a snap-shot of the situation. Only by consulting the manually charted values the physician can see the patient's progress, considering the quantity of bubbles was interpreted correctly. See also: Based on this criteria the surgeon decides on when intervention is necessary or when to remove the drain. In cases when he/she is not sure of the results, it often occurs that the chest drain is left in an additional day just to be on the safe side. An additional day of pain and dependency for the patient.

All these considerations led to the development of Thopaz+

A digital display on Thopaz+ informs nursing staff and physicians about the patient's progress – both in real time and as trending graphs. Based on these criteria, the decision making on when to remove a drain or when to intervene is greatly simplified. This reduces chest tube duration, hospital stay and costs.

Surgeons | The dangers lurking in outdated chest drain solutions
Learn more about the benefits of working with a digital chest drainage system and why physicians prefer using Thopaz+ over underwater seal drains.

Click here to read more on the nurse's perspective or read below the patient's perspective.

The perspective of a patient

ERAS (Enhanced Recovery After Surgery – a perioperative protocol) places the patient at the center of all medical decisions. The multimodal perioperative care pathway is designed to reduce stress for patients, alleviate the amount of pain they experience and crucially, speed up the recovery and mobilization process, where removing invasive lines and drains as soon as possible is essential. Immobility is a critical risk factor for postoperative complications and increases hospital length of stay.4 Complications induced by longer periods of immobility can persist for years after the patient’s discharge.5

Barriers to early mobilization in the ICU include difficulties in handling traditional chest drains. Moreover, even if the patient can be mobilized with a chest drain, this requires disconnection of suction during mobilization and reattachment afterwards. This can lead to an infection risk because of handling mistakes.6 A fast recovery after surgery is influenced by many different factors. One factor is the noise of the system. Conventional underwater seal drains may be noisy, thus impacting the recovery and quality of sleep. Another stress factor for patients with a chest drain is pain. The longer a drain is remaining in a patient´s body the longer the patient suffers under pain.

All these considerations led to the development of Thopaz+

As the physician has a digital display which shows the patient´s progress based on real time and trending data the decision making on when to remove a drain is greatly simplified. This reduces chest tube duration and the patient suffers less days with pain.

Early mobilization is highly improved as Thopaz+ is not connected to a suction source – the suction is integrated into the system. The patient/nurse only needs to grab the Thopaz+ handle and the mobilization can begin. Patients can start with physical therapy already on day one, can meet their family in the cafeteria and are able to go to the toilet independently.

Thopaz+ is very quiet, as it only runs to maintain the set pressure. This enables a faster recovery and better quality of sleep.

Finally, all these factors impact the quality of life which is improved by using the digital chest drain Thopaz+.

Patients | The dangers lurking in outdated chest drain solutions
Learn more about the benefits of working with a digital chest drainage system and why patients prefer Thopaz+ over underwater seal drains.

Thopaz+ takes chest drainage therapy to a new level of care

  • Thopaz+ reduces chest tube duration and length of stay (in hospital).
  • Improves safety for people with chest drains.
  • Improves clinical decision-making through continuous objective monitoring of air leaks and fluid loss.
  • Increases patient mobility.
  • Clinical staff find Thopaz+ more convenient and easier to use than conventional chest drainage systems.
  • Visit our FAQ for more information about safe chest drain management.


1 Aguayo E, Cameron R, Dobaria V et al. Assessment of Differential Pressures in Chest Drainage Systems: Is What You See What You Get? J Surg Res 2018;232: 464–9.

2 Refai M, Brunelli A, Varela G, et al. The Values of Intrapleural Pressure Before the Removal of Chest Tube in Non-Complicated Pulmonary Lobectomies. Eur J Cardiothorac Surg 2012;41(4):831–3.

3 Brunelli A, Salati M, Pompili C, et al. Regulated Tailored Suction vs Regulated Seal. A Prospective Randomized Trial on Air Leak Duration. Eur J Cardiothorac Surg 2013;43(5):899–904.

4 Batchelor T, Rasburn N, Abdelnour-Berchtold E, Brunelli A, Cerfolio R. J., Gonzalez M et al. (2018): Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). In: Eur J Cardiothorac Surg 55 (1), S. 91–115. DOI: 10.1093/ejcts/ezy301.

5 Patricia A, Macarena R, Juan G, Daniel F, Rehabilitation and early mobilization in the critical patient, systematic review, J. Phys. Ther. Sci. 30: 1193–1201, 2018.

6 Rathinam S, Bradley A, Cantlin T, Rajesh P (2011), Thopaz Portable Suction Systems in Thoracic Surgery: an end user assessment and feedback in a tertiary unit, Journal of cardiothoracic surgery 6, S. 59. DOI: 10.1186/1749-8090-6-59.

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