Chest drain insertion

Summary

Definition

A chest drain is a conduit for the removal of air or fluid from the pleural cavity. Three components are required: the chest drain itself, a container for collection (placed below the level of the chest) and a valve mechanism such as an underwater seal or Heimlich valve.

Indications

Pneumothorax (especially in ventilated patients)

Traumatic haemopneumothorax

Postoperative – e.g. thoracotomy, oesophagectomy, cardiac surgery

Large malignant pleural effusions

Empyema and complicated parapneumonic pleural effusion.

Pre-procedure considerations

1. ▪ Obtain a pre-procedure chest X-ray except in the case of tension pneumothorax, and confirm site/side.

2. ▪ Consider risks: correct any coagulopathy where possible, take care with differential diagnosis of pneumothorax and bullous disease.

3. ▪ Drainage of a post-pneumonectomy space should only be carried out after consultation with a cardiothoracic surgeon.

4. ▪ Explain the procedure and obtain patient consent.

5. ▪ Consider premedication (opiate or benzodiazepine) if patient conscious.

6. ▪ Consider image guidance if unable to aspirate free air/fluid with a needle.

7. ▪ Prophylactic antibiotics e.g. a cephalosporin should be given in trauma cases.

8. ▪ Prepare equipment including chest drain set, sterile preparation, local anaesthetic, underwater seal drain, silk suture, scalpel, dressings and pulse oximeter.

Procedure

1. ▪ Position the patient correctly – either on a bed, hand behind head on the side of insertion to expose the axilla, upright leaning over a table with a pillow or in the lateral decubitus position. Patient should be on oxygen and have peripheral access.

2. ▪ Identify the site – fifth intercostal space in the mid-axillary line, above the rib to avoid the neurovascular bundle.

3. […]