Paediatric patients with underwater seal chest drains are cared for in certain areas within a paediatric hospital setting. Presently within a paediatric hospital in New Zealand there is a clinical underwater seal chest drain guideline to guide chest drain insertion, management, and removal yet there is inconsistency in what the guideline states and current practice. This quality improvement project undertook a integrative review of the international literature on underwater seal chest drain management and explored healthcare workers perceptions and knowledge on the management and removal of underwater seal chest drains in children and young people at a large children’s hospital in New Zealand.

Method: An integrative review was undertaken to summarise previous international empirical peer-reviewed literature published from 2011 - 2022 to provide a comprehensive understanding on the management and removal of underwater seal chest drains in children and young people. A qualitative design using face-to-face interviews with healthcare professionals from one large children’s hospital in New Zealand who had a key role in underwater seal chest drain management and removal was undertaken in 2022.

Analysis: The integrative review and face to face interview data were analysed separately using the six phases of Braun and Clarks’ (2006) thematic analysis. This included familiarising oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and generating a report. The findings of both research designs were brought together in the discussion.

Results: A total of nine studies were included in the review. An inductive analysis of nine manuscripts generated one theme (disparity in healthcare professionals’ knowledge and practice with underwater seal chest drain management), three sub-themes (healthcare professionals, practice considerations, adverse events) and nine categories (discipline and context, knowledge, education, indications, underwater seal chest drain tubing and characteristics, management, assessment, complications, interventions). Face to face interviews were undertaken with seven healthcare professionals. An inductive analysis of the interviews generated one theme (a gap between theory, guidelines and practice of underwater seal chest drain management), four subthemes (management, practice considerations, scope of practice, current practice), eleven categories (collaboration, care delivery, indications, insertion-removal, adverse events, guidelines, knowledge, demographics, reality, ability, context). The results highlighted that there was a disparity in healthcare professionals’ knowledge and practice with underwater seal chest drain management as well as a gap between theory, guidelines and reality of practice for underwater seal chest drain management.

Conclusion: There is a lack of research for underwater seal chest drain management and removal, particularly in paediatrics. There is a discrepancy between healthcare professionals’ perceptions and knowledge of underwater seal chest drain management and removal, to what is required to manage and remove underwater seal chest drains safely and effectively. There is an urgent need to provide healthcare professionals with the relevant education and knowledge to be able to adequately care for children with underwater seal chest drains and ultimately prevent any adverse events. It is also recommended that healthcare professionals utilise contemporary evidence-based research to create and update clinical practice guidelines for underwater seal chest drain management and removal.