The importance of an interdisciplinary endeavour is the capacity of multiple professionals with different backgrounds working together to deliver higher quality care [1]. The concept of medicine as an isolated discipline concerned with the restoration of health has been replaced with the concept of different health professionals working together to maintain health [2]. This type of team-based learning can occur in either academic or clinical settings, during medical school and residency, and consist of any combination of professional groups [3]. Interdisciplinary collaboration in health care is crucial to offering patient-centred care, and working collaboratively is not only essential but also crucial in providing quality and safety in patient-centred care [2]. In the thoracostomy procedure, the physician/surgeon and nursing teams must work together to achieve patient care, sharing tasks and responsibilities [2].
Thoracic drainage is a surgical technical procedure that is frequently used in urgent and critical, potentially life-threatening traumatic situations [4]. These drains have been integrated into routine practice because they are simple, effective tools to manage chest trauma and pleural pathologies [5]. However, it is important to highlight the invasiveness of such techniques. Insertion of the tube remains the physician’s responsibility [6]. The physician’s proficiency during an emergency and anatomical knowledge of the involved structures are required for the accurate positioning and standardized execution of the procedure [7]. However, even though nurses do not insert the tube, they play an important role with major responsibilities during the thoracostomy procedure. These include, for example, monitoring the container and the suction level and recording the quantity, characteristics, and content of the drainage; monitoring air-leakage; administration of pain medicine; and providing information and education strategies to patients so that they can be active in their self-rehabilitation process [6]. Nurse practitioners and physician assistants can also be involved in this teamwork.
Nursing care can be pre-procedure or post-procedure. During pre-procedural care, consent is required to perform the procedure and provision of information about the reason for and risks of the thoracostomy. Depending on the country and legislation, this action may be the responsibility of the surgeon or the physician or the nurse. They must also ensure that the patient has no doubts, and understands what will happen and what the course of treatment will entail. It is important that the nurse prepare the appropriate materials for insertion of the chest tube and later assist in the procedure, or as mentioned above, according to country and legislation, they can also perform it. During the procedure, the nurse’s priority is to monitor the patient’s response. Post-procedural care involves monitoring vital signs, helping the patient to change position, protecting the drainage system, and helping to remove the tube when necessary [8, 9]. Nurses must also teach the patient proper management of the drainage device: how to keep the bottle or the closed plastic system below the level of the chest, and to report any dysfunction [5]. Because inefficient nursing care can cause complications, educational material with information for safety and care strategies should be available for these patients [5, 8].
For these skills, an interdisciplinary care approach is fundamental. In this context, the theme of interdisciplinarity has recently been more widely addressed and studied. Interdisciplinary means integrated across disciplinary knowledge and methods from different fields in the interests of problem solving [10].
Lastly, to organize interdisciplinary care, the use of protocols is required. Care protocols are defined as systematized orientations that prioritize critical and basic situations to streamline the decision-making process. These protocols can be organized as flowcharts, usually elaborated by the institution’s experts [11]. Care protocols facilitate the organization of the work process by standardizing procedures [12]. These protocols are an interdisciplinary approach to care, which encourages teamwork and consistency in patient care.
LITERATURE REVIEW
Aim
This integrative literature review aimed to search for articles related to the thoracostomy procedure that convey the procedure and the standard care to the medical staff and the nursing team, and interdisciplinary teamwork.
The databases searched and other information sources
The search was performed in the following databases: Medical Literature Analysis and Retrieval System Online – PubMed® (National Library of Medicine) and Scientific Electronic Library Online – SciELO. PubMed® includes citations for biomedical literature from MEDLINE, life science journals, and online books. SciELO is an electronic library providing access to scientific journals in Portuguese and Spanish.
Search strategy and intervention
This is an integrative literature review, with a qualitative approach [13]. The steps were: (1) choice of research objective; (2) definition of the criteria for inclusion and exclusion of studies; (3) search of databases; (4) inclusion of selected studies in frame format; (5) analysis of results, identifying differences and conflicts; and (6) discussion and analysis of results.
Data collection process and search outcomes
Application of inclusion and exclusion criteria (1st stage), which contained the descriptors listed in the medical subject headings (MeSH): “Chest Tube AND Nursing; Chest Tube AND Care; Chest Tube AND Drainage; Chest tube AND Insertion (this descriptor was not defined by the MESH, but by its appearance in many articles)”. And the descriptors should refer to the insertion of the chest drain into humans. Publications were selected when they were available in English, Portuguese, Spanish, or French. Exclusion criteria were as follows: theses; dissertations; abstracts of works published in annals of events; editorials; letters to the editor; and articles not available online and not free to access.
The second step was to read the titles and abstracts, and the third step was to read the full article and delete repetitive or irrelevant studies. Five relevant manuscripts were used in addition to the development of the literature review because they were of great relevance, so they did not go through the selection process [14–18]. Critical evaluation of the studies was based on the results of the aforementioned reference documents, and from reviewing of the articles found in the databases, and selection of information relevant to the theme in its context in the study.
Study design
Data collection on teamwork in thoracostomy from the literature, between January 2012 and September 2020, was done in December 2020.
Quality assessment
To validate the integrative review methodology, prior to conducting the research, a protocol was developed. This research protocol was endorsed by an expert researcher on methods of integrative review and another expert researcher in the area of thoracostomy and interdisciplinary teamwork. This was done in order to validate the descriptors and their relevance to the subject. This research was exempt from Ethics Committee approval because it did not involve human beings.
Data abstraction and process
The collection of the articles was carried out in each database individually. The beginning and/or ending was not predefined, i.e. it occurred randomly. The selection criteria and the process are shown in Figure 1.
Synthesis
For the analysis procedure, we opted for content analysis [19]. This analysis was developed via 3 steps: (1) pre-exploration of the material or floating readings; (2) selection of units of analysis (or units of meanings); and (3) the non-priority categorization and sub-categorization process. The categories emerged entirely from the context of the research material. This procedure required the researchers to go back and forth from the reading of the material analysed and the objectives of the study. Each emerging category was discussed in the form of a frame within the information relevant to the study in a comparative way, along with the extraction of new information to enrich the theme.
Study risk of bias assessment and confidence in the assessment process
Two reviewers systematically evaluated the abstracts and articles to limit the risk of bias in the included or excluded studies. Only studies approved by the 2 reviewers were retained. During the analysis process, the reviewers worked independently. In the case of discrepancies in the outcome analyses, a third reviewer designated by the principal investigator reread the article.
RESULTS
After insertion of the descriptors, and before the application of the inclusion criteria, 11,277 articles were found. Most of the articles were found in Medline (99.0%). Inclusion and exclusion criteria, as well as the subsequent stages of evaluation of the articles, were applied. After excluding articles that did not meet the objective of our study, 475 abstracts were analysed (Table 1). Finally, the 19 selected articles were categorized according to Table 2, in articles with content focused on nursing care, content related to medical and surgical procedures, and interdisciplinary content.
After categorization and analysis of the data, extra information emerged regarding new simulation technologies in the insertion of the chest drain that can influence the quality and success of the procedure, or even contribute to the development of new interdisciplinary procedures (Table 3). Additional themes were developed, and they included the following: experimentation with a new method and/or technology, using an alternative model to teach and evaluate drainage, considering patient characteristics and pathophysiology in the insertion of the chest drain in view of preventing complications, as well as highlighting the importance of involving nurses in the development of new techniques and procedures of chest drainage.
DISCUSSION
After exhaustive reading of selected articles and seeking to meet the study objective, according to the application of the content analysis method, the categories discussed below emerged.
Divergences in carrying out the procedure
When comparing the literature for insertion of chest drains [14–18] and articles found in the literature review, we identified differences between the procedure and care guidelines, with some divergences that could change fundamental aspects of practice, one of which is in the execution of a surgical procedure. This category, in which the closed thoracostomy is included, is strict regarding surgical asepsis. It involves patient safety as a key point, to avoid unnecessary patient complications such as discomfort and risk of death [27].
Given the importance of this, one of the divergences in the literature concerns the most adequate antiseptic in the preparation of the patient for the chest drain insertion procedure. While some studies [5] mention povidone-iodine as the preferred solution, other studies refer to alcohol-based products (chlorhexidine) [18]. Chlorhexidine may be 6% to 10% more effective in preventing infections in surgical procedures compared to povidone-iodine in patients with the same characteristics [34, 35]. Another systematic review achieved the same level of evidence and considered the reduction of costs when using alcoholic chlorhexidine (up to $26 per procedure) [36]. Several authors state that the option with the lowest incidence of infection and the highest cost-benefit is chlorhexidine alcohol [14, 34–36]. Another point of divergence in the literature is the use of 1% lidocaine [14] versus using 2% lidocaine [29] versus using neither [8]. In the literature, there are no high-quality studies on the benefits or efficacy of one over the other, only indications of different dosages, and other articles also indicate that both concentrations are acceptable [37, 38].
Success in performing a thoracostomy is related not only to the insertion of the chest tube but also to its maintenance. Basic care to ensure its effectiveness and patency are necessary. Dressing was one of the points addressed in the articles and literature of reference [8, 15–18]. Some studies recommend, as a cover, a simple dressing with petroleum gauze or lint gauze covered with micropore or tape [14–16], while others recommend transparent dressing [8]. When comparing issues such as level of skin irritation, the literature reveals that both dressings showed the same performance, but that with regards to the level of wound recovery and costs, transparent dressing presented more positive results [39, 40]. In addition to other benefits, transparent dressing decreases the risk of infection and requires a smaller number of exchanges because it can be maintained for 3 to 7 days. To conclude, transparent dressing is the most suitable for the protection of the insertion site on the chest.
As a complementary aspect, 2 studies discuss pain control and analgesia as one of the fundamental procedures in pre- and post-surgical care [6, 8]. Pain can cause patient instability leading to failure, and/or it can become the main cause of complications during and after the procedure, and it increases the length of hospital stay. Therefore, professionals should value assessment of the aspects that involve the reduction of pain and reinforce patient’s confidence in safe relevant strategies [41, 42].
Interdisciplinary action and the quality of the procedure
It is essential to promote interprofessional healthcare education and training [43]. Among the 19 studies in the systematic review, 14 only approached chest drain insertion techniques for physicians or medical students [4, 21–33]. None studied interdisciplinary work in drain insertion or chest drain care, and only 1 presented any protocol for teaching and training students in drainage [28]. On the other hand, 5 studies presented nurses as the main actors, 1 of which was an evidence-based guideline on nursing practices in the management and care of the chest drain [15], while the other 4 evaluated nurses’ knowledge and practices about chest drain care [5, 6, 8, 20]. One study, elaborated by a surgical department of thoracic surgery [8], showed how important it is to know the other professions’ roles and their importance in patient health care. It also demonstrated how it is possible to enlarge vision to interdisciplinary teamwork to improve health care. When the general principles on the care of patients with thoracic drains are implemented correctly and effectively by nurses, it will accelerate the healing process [6]. Other studies confirm the importance of the procedure protocols; once they are standardized and systematized, patient care is substantially improved. In addition, the authors suggest that nurses’ knowledge of chest anatomy and physiology is critical for rapid intervention when patients with chest drains present complications, and that the nurse must also know the reason for insertion of the drain, thereby raising awareness of the care procedures needed to maintain patient safety [6].
Finally, only 1 study directly approached the doctor-nurse partnership in the procedure and care of the chest drain, including multidisciplinary collaboration as a key point in patient care. An interdisciplinary approach to patient care is fundamental because each professional has his/her own functions and roles during chest drain insertion and care; however, all must work together for the best patient outcome [20]. Collaboration among nurses and physicians allows better patient-centred care [2]. It is also important to emphasize that the chest drain training programs should include the presence of a nurse during the insertion procedure and that national and international guidelines should emphasize the roles and duties of the nurse in the care of the patient with a chest drain [6].
Use of protocols for patient safety
Among the 20 studies evaluated in the integrative review of the literature, only 5 reported the use of protocols for insertion and management of the chest drain [6, 20, 24, 29, 33]. Two of them approached the use of protocols for teaching and training for medical students and physicians in the technique of insertion of the drain [29, 31]. Another study commented on the partnership between doctors and nurses in the care of patients with a chest tube [20]. This study assessed patient satisfaction with the ability of nurses to manage postoperative needs in a ward-based nurse-led clinic managing patients after thoracic surgery. The use of a protocol for outpatient care was created with the aim of allowing the nurses to provide their own independent care, with the option to request a physician if necessary. Most of the patients (99%) were satisfied with the care. Among the two-thirds of patients who were treated according to the protocol and without referring to a physician, very few considered that a medical consultation was necessary. Another article described a step-by-step approach for ultrasound-guided chest tube drainage [24]. Finally, a study evaluating nurses’ knowledge on chest drains suggested the creation of protocols for drainage care [6].
Patient safety needs to be the priority to the health care team [44]. Studies show that the use of evidence-based protocols contributes to patient safety, because nurses are thereby trained in patient care and are given knowledge of drainage systems [45] and the types of drainage to expect from whichever device is inserted into a patient. They can also contribute to patient safety and prevent potential harm because they can collaborate in the rehabilitation process since adequate drainage management improves effectiveness [45]. In addition, some authors argue that protocols may improve communication between doctors and nurses during care and that a standardized document improves interdisciplinary communication and drainage care [45]. Thus, it is fundamental that protocols involving procedures and patient care can be developed to delineate each discipline’s roles and responsibilities. Another fundamental factor in patient care is education. Providing patients with accurate and easy to understand information decreases recovery time and increases positive outcomes [16].
New technologies for the insertion of chest tubes
Studies also discussed the use of technology for the instruction of procedural techniques [4, 29, 33]. The use of animal models that mimic human physiology enables the development of practical skills, given the high cost and lack of accessibility of simulators or cadaver labs. Other studies go further and seek alternatives with materials that can achieve high fidelity without high-cost technology, developing their own instruments with recycled materials and proving their effectiveness for improved learning [30]. Low-cost training models for chest tube insertion were developed and tested [28, 46]. The use of a low-cost 3D-printed model for medical teaching of the procedure was analysed [21]. This model is cost-effective and valid for teaching thoracostomy. Another approach emphasized the importance of expanding knowledge of the procedure beyond the medical domain, encouraging interdisciplinary activity, and deepening knowledge and nursing responsibilities in chest drain insertion [5, 8, 20]. In this context, it behoves us to mention digital chest drainage, using digital devices that have been proven to have important benefits such as objective assessment of real air-leak, early active intervention or conversion to a one-way valve system that would allow for outpatient management, early patient mobilization, and therefore early hospital discharge [47]. Another important component is thoracic ultrasound, an imaging diagnostic technique that helps to identify the best puncture site and guides the procedure for insertion of the drainage. Chest ultrasound is essential during these invasive manoeuvres to increase safety and decrease potentially fatal complications [48].
Future research
Interdisciplinarity represents the combined courses of 2 or more disciplines like nursing and medicine [49]. In healthcare settings, clinical situations like life-threatening events require interprofessional management of the patient based on the unique disciplinary knowledge of the health professionals [49]. Reeves and Zwarenstein [50–53] have demonstrated in several studies that that interprofessional teamwork improves healthcare outcomes. When analysing the existing literature on thoracostomy and care, we can identify a large number of studies. Notwithstanding this vast amount of information, the literature is fragmented into disciplines and isolated analyses. Each discipline addresses the aspects that pertain to its own responsibilities in the execution of the procedure, but in practical reality, all actions have the same orientation (the patient’s well-being), and the different disciplines need to act together. This study enabled a comparison of surgical and nursing practices in the placement of chest drains through a dialogue with several authors on integration review and content analysis, compiling the information and defining an international standard for the procedure and materials used. From this study, it was possible to define an interdisciplinary and updated practice with safe means promoting safe chest drain insertion. Future research should aim to develop a learning and assessment tool for interdisciplinary chest tube insertion. Finally, future studies should concentrate on extensive patient education. It is essential in this type of interdisciplinary care to consider patient education and, more specifically, to train him/her in the management of thoracic drainage [54, 55].
CONCLUSIONS
Chest tube insertion should be interdisciplinary, to encourage improved teamwork organization, and not fragmented into disciplines and isolated analyses. This review is a source of rich information that can instrumentalize the creation of optimized processes for the interdisciplinary procedure of insertion of the chest drain. Therefore, it is necessary to develop interdisciplinary research bringing these results closer to multidisciplinary reality. The protocols are a good strategy, which are oriented and stimulated by health organizations promoting increased patient safety. The evaluation of interprofessional practices could also create a standard of techniques and materials that could be used internationally to become a reference for safe practice. Construction of interdisciplinary practice promotes improvement and qualification in health services, contributing to the development of research processes and the evolution of healthcare as a whole. It is also important to emphasize the importance of expanding this study, considering aspects such as patient education for self-care, monitoring air-leakage with an interdisciplinary view, proper handling during patient transport, and care according to each context (emergency, hospitalization, home).
ACKNOWLEDGEMENTS
The authors would like to thank Jeffrey Arsham, an American medical translator, for reviewing the English-language text.
Financial support and sponsorship: none.
Conflicts of interests: none.
1. World Health Organization. Interprofessional collaborative practice in primary health care: nursing and midwifery perspectives. WHO Document Production Services; 2013. Available at: http://www.who.int/hrh/resources/IPE_SixCaseStudies.pdf (Accessed: 10.01.2021).
2.
Towle A. Nurses must knock down professional “silos” and create quality, safe and effective interprofessional teams. From the inside looking out: a healthcare providers experience being the family member. J Nurs Care 2016; 5: 341. doi: 10.4172/2167-1168.1000341.
3.
O’Connor S. An interprofessional approach: the new paradigm in nursing education. J Adv Nurs 2018; 74: 1440-1442. doi: 10.1111/jan.13530.
4.
Netto FACS, Sommer CG, De Mello Constantino M, Cardoso M, Cipriani RFF, Pereira RA. Projeto de ensino: modelo suíno de baixo custo paratreinamento Projeto de ensino: modelo suíno de baixo custo para treinamento de drenagem torácica. Rev Col Bras Cir 2016; 43: 60-63. doi: 10.1590/0100-69912016001012.
5.
Elfaki BA, Mustafa HE, Ahmed AH. Nurses’ knowledge and practice regard care of patient with chest drains in Sudan Heart Center, Khartoum, Sudan. IOSR Journal of Nursing and Health Science 2016; 5: 1-6. doi: 10.4103/1596-3519.172556.
6.
Tarhan M, Gökduman SA, Ayan A, Dalar L. Nurses’ knowledge levels of chest drain management: a descriptive study. Eurasian J Pulmonol 2016; 18: 153-159. doi: 10.5152/ejp.2016.97269.
7.
Friedrich M, Bergdolt C, Haubruck P, et al. App-based serious gaming for training of chest tube insertion: study protocol for a randomized controlled trial. Trials 2017; 18: 56. doi: 10.1186/s13063-017-1799-5.
8.
Kesieme EB, Essu IS, Arekhandia BJ, Welcker K, Prisadov G. Nurses’ knowledge of care of chest drain: a survey in a Nigerian semiurban university hospital. Ann Afr Med 2016; 15: 28-33. doi: 10.4103/1596-3519.172556.
9.
Hood B, Henderson W, Pasero C. Chest tube removal: an expanded role for the bedside nurse. J Perianesth Nurs 2014; 29: 53-59. doi: 10.1016/j.jopan.2013.11.001.
10.
Abreu S, Caldeira A, Costa AR, Gomes T, Roque LAC. Interdisciplinary team work applying working methods to a math project. 2nd International Conference of the Portuguese Society for Engineering Education (CISPEE), Vila Real, 2016. pp. 1-6. doi: 10.1109/CISPEE. 2016.7777729.
11.
Silva JASV, Hinrichsen SL, Brayner KAC, Vilella TAS, Lemos MC. Glosas hospitalares e o uso de protocolos assistenciais: revisão integrativa da literatura. Rev Adm Saúde 2017; 17: 1-18.
12.
Vieira LJES, Silva ACF, Moreira GAR, Cavalcanti LF, Silva RM. Protocolos na atenção à saúde de mulheres em situação de violęncia sexual sob a ótica de profissionais de saúde. Cięnc Saúde Colet 2016; 21: 3957-3965. doi: 10.1590/1413-812320152112.15362015.
13.
Ganong LH. Integrative reviews of nursing research. Res Nurs Health 1987; 10: 1-11. doi: 10.1002/nur.4770100103.
14.
Ghazali DA, Léger A, Petitpas F, Guéchi Y, Boureau-Voultoury A, Oriot D. Development and validation of a performance assessment scale for chest tube insertion in traumatic pneumothorax. J Pulm Respir Med 2016; 6: 1-6. doi: 10.4172/2161-105X.1000346.
15.
Caroll P. Evidence-based care of patients with chest tubes. American Association of Critical-Care Nurses. National Teaching Institute Boston, MA; 2013. Available at: https://chestdrainu.com/wp-content/uploads/2018/09/nti-expoed-slides-chest-drainage-2016.pdf (Accessed: 10.01.2021).
16.
Lúcio VV, Araújo APS. Nursing care in thoracic drainage: a literature review. UNOPAR Cient Cięnc Biol Saúde 2011; 13(Esp): 307-314.
17.
Briggs D. Nursing care and management of patients with intrapleural drains. Nurs Stand 2010; 24: 47-55. doi: 10.7748/ns2010.01.24.21.47.c7489.
18.
Shelly P, Nascimento B Jr, Simone C, Chein V. Chest-tube insertion. New Engl J Med 2007; 357: e15. doi: 10.1056/NEJMvcm071974.
19.
Bardin L. Content Analysis. Lisbon: Editions 70, LDA; 2009.
20.
Williams S, Williams J, Tcherveniakov P, Milton R. Impact of a thoracic nurse-led chest drain clinic on patient satisfaction. Interact Cardiovasc Thorac Surg 2012; 14: 729-733. doi: 10.1093/icvts/ivs056.
21.
Garland C, Wilson JA, Parsons MH, Dubrowski A. The application of low-fidelity chest tube insertion using remote telesimulation in training healthcare professionals. Cureus 2019; 11: e6273. doi: 10.7759/cureus.6273.
22.
Haubruck P, Nickel F, Ober J, et al. Evaluation of app-based serious gaming as a training method in teaching chest tube insertion to medical students: randomized controlled trial. J Med Internet Res 2018; 20: e195. doi: 10.2196/jmir.9956.
23.
Hertz P, Jensen K, Abudaff SN, Strøm M, Subhi Y, Lababidi H, Konge L. Ensuring basic competency in chest tube insertion using a simulated scenario: an international validation study. BMJ Open Respir Res 2018; 5: e000362. doi: 10.1136/bmjresp-2018-000362.
24.
Menegozzo CAM, Utiyama EM. Steering the wheel towards the standard of care: proposal of a step-by-step ultrasound-guided emergency chest tube drainage and literature review. Int J Surg 2018; 56: 315-319. doi: 10.1016/j.ijsu.2018.07.002.
25.
Ober J, Haubruck P, Nickel F, et al. Development and validation of an objective assessment scale for chest tube insertion under ‘direct’ and ‘indirect’ rating. BMC Med Educ 2018; 18: 320. doi: 10.1186/s12909-018-1430-9.
26.
Tan TX, Buchanan P, Quattromani E. Teaching residents chest tubes: simulation task trainer or cadaver model? Emerg Med Intern 2018; 2018: 9179042. doi: 10.1155/2018/9179042.
27.
Ritchie M, Brown C, Bowling M. Chest tubes: indication sizing, placement, and management. Clin Pulm Med 2017; 24: 37-53. doi: 10.1097/CPM.0000000000000188.
28.
Léger A, Ghazali DA, Petitpas F, Guéchi Y, Boureau-Voultoury A, Oriot D. Impact of simulation-based training in surgical chest tube insertion on a model of traumatic pneumothorax. Adv Simul (Lond) 2016; 1: 21. doi: 10.1186/s41077-016-0021-2.
29.
Tube MIC, Netto FA, Costa E, et al. Chest drainage teaching and training for medical students. Use of a surgical ex vivo pig model. Acta Cir Bras 2016; 31: 353-363. doi: 10.1590/S0102-865020160050000010.
30.
Salamonsen MR, Bashirzadeh F, Ritchie AJ, Ward HE, Fielding DI. A new instrument to assess physician skill at chest tube insertion: the TUBE-iCOMPT. Thorax 2015; 70: 186-188. doi: 10.1136/thoraxjnl-2013-204914.
31.
Shefrin AE, Khazei A, Hung GR, Odendal LT, Cheng A. The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency. CJEM 2015; 17: 140-147. doi: 10.2310/8000.2014.141406.
32.
Gupta AO, Ramasethu J. An innovative nonanimal simulation trainer for chest tube insertion in neonates. Pediatrics 2014; 134: 798-805. doi: 10.1542/peds.2014-0753.
33.
Lopez JM, Saad R Jr, Dorgan Neto V, Botter M, Gonçalves R, Riva- ben JH. Technical validation of pulmonary drainage for the treatment of severe pulmonary emphysema: a cadaver-based study. J Bras Pneumol 2013; 39: 16-22. doi: 10.1590/s1806-37132013000100003.
34.
Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010; 362: 18-26. doi: 10.1056/NEJMoa0810988.
35.
Levin I, Amer-Alshiek J, Avni A, Lessing JB, Satel A, Almog B. Chlorhexidine and alcohol versus povidone-iodine for antisepsis in gynecological surgery. J Womens Health (Larchmt) 2011; 20: 321-324. doi: 10.1089/jwh.2010.2391.
36.
Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010; 31: 1219-1229. doi: 10.1086/657134.
37.
Villanueva C, Doyle M, Parikh R, Manganas C. Patient safety during chest drain insertion – a survey of current practice. J Patient Saf 2021; 17: e115-e120. doi: 10.1097/PTS.0000000000000304.
38.
Kuhajda I, Zarogoulidis K, Kougioumtzi I, et al. Tube thoracostomy; chest tube implantation and follow up. J Thorac Dis 2014; 6 (Suppl 4): S470-S479. doi: 10.3978/j.issn.2072-1439.2014.09.23.
39.
Jones SKB. Chest tube dressings: a comparison of different methods. Dissertations; 2011: 394. Available at: https://irl.umsl.edu/dissertation/394.
40.
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: 58-65. doi: 10.1097/XEB.0000000000000041.
41.
Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am 2015; 95: 301-318. doi: 10.1016/j.suc.2014. 10.002.
42.
Barbosa MH, Corrêa TB, Araújo NF, et al. Pain, physiological alterations and analgesia in patients submitted to medium-sized surgeries. Rev Eletrônica de Enf 2014; 16: 142-150. doi: 10.5216/ree.v16i1. 20991.
43.
Bianchi M, Bressan V. Effectiveness of interprofessional education and new prospects. J Adv Nurs 2019; 75: 14-16. doi: 10.1111/jan.13772.
44.
World Health Organization. Patient safety: making health care safer; 2017. Available at: https://apps.who.int/iris/bitstream/handle/10665/255507/WHOHIS-SDS-2017.11-eng.pdf;jsessionid=610A16BFF23692B8E56C7917A5DCFF9B?sequence=1 (Accessed: 10.01.2021).
45.
Tsang LF, Cheng HC, Ho HS, et al. Translating evidence-based protocol of wound drain management for total joint arthroplasty into practice: A quasi-experimental study. Int J Orthop Trauma Nurs 2016; 21: 49-61. doi: 10.1016/j.ijotn.2015.07.002.
46.
Ghazali DA, Breque C, Leger A, Scepi M, Oriot D. Testing of a complete training model for chest tube insertion in traumatic pneumothorax. Simul Healthc 2015; 10: 239-244. doi: 10.1097/SIH. 0000000000000071.
47.
Marulli G, Comacchio GM, Nosotti M, et al. Multicenter randomized study on the comparison between electronic and traditional chest drainage systems. Trials 2019; 20: 2-8. doi: 0.1186/s13063-019-3811-8.
48.
Vetrugno L, Guadagnin GM, Orso D, et al. An easier and safe affair, pleural drainage with ultrasound in critical patient: a technical note. Crit Ultrasound J 2018; 10: 18. doi: 10.1186/s13089-018-0098-z.
49.
Rizzo Parse R. Interdisciplinary and interprofessional: what are the differences? Nurs Sci Q 2015; 28: 5-6. doi: 10.1177/0894318414558624.
50.
Reeves S, Xyrichis A, Zwarenstein M. Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice. J Interprof Care 2018; 32: 1-3. doi: 10.1080/13561820.2017.1400150.
51.
Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; 6: CD000072. doi: 10.1002/14651858.CD000072.pub3.
52.
Reeves S, van Soeren M, Macmillan K, Zwarenstein M. Medicine and nursing: a social contract to improve collaboration and patient-centred care? J Interprof Care 2013; 27: 441-442. doi: 10.3109/ 13561820.2013.846033.
53.
Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013; 2013: CD002213. doi: 10.1002/14651858.CD002213.pub3.
54.
Roman M, Weinstein A, Macaluso S. Primary spontaneous pneumothorax. Medsurg Nurs 2003; 12: 161-169.
55.
Brubacher S, Gobel BH. Use of the pleurx pleural catheter for the management of malignant pleural effusions. Clin J Oncol Nurs 2003; 7: 35-38. doi: 10.1188/03.CJON.35-38.
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