Gravity Drainage Versus Forced Suction Drainage for Patients With Excess Fluid in Pleural or Peritoneal Spaces

The sampling of a small quantity of fluid for diagnostic intents or the removal of a large quantity of fluid for therapeutic purposes from the pleural space (i.e., between the lungs and chest wall) and the peritoneal space (i.e., abdominal cavity) is known as thoracentesis and paracentesis, respectively., Some causes for excess fluid in the pleural space — pleural effusion — include trauma (e.g., puncture wounds), surgical complications, infection (e.g., tuberculosis), and disease (e.g., cancer, heart failure). Common causes for excess fluid — ascites — in the peritoneal space include cirrhosis, cancer, infection, dialysis, and heart disease. For the drainage of excess fluid, a needle or tube is inserted into the pleural or peritoneal space., Health care providers may attach a syringe to the needle to aspirate directly or attach the tube to a water-seal drain with or without forced suction. The water seal acts as a one-way valve, which allows air to escape and prevents it from reentering the patient. When no suction is applied to the water-seal drain, it is using the force of gravity to drain fluid. Alternatively, the water-seal drain can be attached to external wall suction, which typically expedites the drainage of fluid and air. However, it is uncertain if forced suction results in direct patient benefits and/or complications. The aim of this report is to summarize and critically appraise the relevant clinical evidence and evidence-based guidelines regarding the clinical effectiveness or use of pleural or peritoneal space drainage with gravity or forced suction.