Chest drain

From Ganfyd

May be improvised from a urinary catheter, coathanger, Swiss Army knife and bottle of brandy.^[1] Presterilised packages are also available.

Medical device to drain fluid for the pleural cavity.

Technique

• 'Open' technique
• Seldinger technique
• Can be tunnelled for longer term usage - useful in intractable (mainly malignant) effusions where pleurodesis not an option so as to allow the patient home.

Equipment

'Open' technique

• Chest drain (more than one, choice of sizes)
• Antiseptic
• Drape
• Glove/gowns
• Local anaesthetic/needle/syringe
• Underwater seal
• Sterile water (to fill underwater seal bottle)
• Suture material

Procedure

^[2] Safety:

• Don't use trocar
• Safe triangle
• Keep underwater drain below level of chest.
• Confirm correct insertion with chest radiograph.

Removing a Chest Drain

1. Confirm that chest drain can be removed.

   This depends on the original indication for the chest drain. Assess the patient's clinical state, check drain output (fluid and airleak) and assess most recent chest radiograph.

2. Explain procedure to patient.
3. Cut securing sutures.

   Note that there may be two sutures - one to hold the drain in place and another purse string or mattress suture intended for closure - don't cut the wrong one!

4. Make sure the patient is breathing and and out slowly. Watch the patient's breathing pattern until you can confidently identify the beginning of inspiration and expiration.
5. Early in expiration, pull out drain smoothly and swiftly as slow, jerky movements are more likely to be painful.

   If a significant length of the tube is in the pleural cavity, do this stage in steps.

6. Tie suture and cover with wound dressing.

   If the closing suture was not placed at time of insertion, occlude the wound with a gauze, then close with suture or with adhesive dressing.

7. Post-removal chest radiograph (approximately 1 hour after)

References