Medical device to drain fluid for the pleural cavity.
- '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.
- Chest drain (more than one, choice of sizes)
- Local anaesthetic/needle/syringe
- Underwater seal
- Sterile water (to fill underwater seal bottle)
- Suture material
- Don't use trocar
- Safe triangle
- Keep underwater drain below level of chest.
- Confirm correct insertion with chest radiograph.
Removing a Chest Drain
- 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.
- Explain procedure to patient.
- 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!
- 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.
- 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.
- 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.
- Post-removal chest radiograph (approximately 1 hour after)
- ↑ Wallace TW, Wong T, O'Bichere A, Ellis BW. Managing in flight emergencies. BMJ (Clinical research ed.) 1995;311:374-6. (Direct link - free access).
- ↑ Laws D, Neville E, Duffy J; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the insertion of a chest drain. Thorax. 2003 May;58 Suppl 2:ii53-9. Direct link: http://thorax.bmjjournals.com/cgi/content/full/58/suppl_2/ii53