Chest drain

Question 1

What is the purpose of chest drain insertion?

Answer 1

Creates a one-way valve
=> allowing movement of air or liquid out of the cavity.

Question 2

Give examples of when a chest drain may be indicated

Answer 2

Pleural effusion
Pneumothorax
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
penetrating chest wall injury in ventilated patients

Question 3

In what cases would a chest drain be contraindicated?

Answer 3

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

Question 4

Where is a chest drain inserted anatomically?

Answer 4

5th intercostal space in the midaxillary line

Question 5

Technique used to insert the drainage tube

Answer 5

Seldinger technique

Question 6

How can the position of a chest drain be confirmed?

Answer 6

1. aspiration of fluid from the drainage tubing
2. ‘swinging’ of the fluid within the drain tubing when the patient inspires
3. chest x-ray

Question 7

Complications of chest dranis which must be discussed during consent

Answer 7

• Failure of insertion
• Bleeding
• Infection
• Penetration of the lung
• Re-expansion pulmonary oedema

Question 8

When should re-expansion pulmonary oedema be suspected?

Answer 8

Usually preceded by the onset of a cough and/or shortness of breath.

Question 9

What should you do if you suspect re-expansion pulmonary oedema?

Answer 9

1. CLAMP the chest drain
2. Order urgent CXR

Question 10

How can we aim to prevent re-expansion pulmonary oedema?

Answer 10

• drain tubing should be clamped regularly if rapid fluid output

i.e. drain output should not be >1L of fluid over 6 hours

Question 11

When should a chest drain be removed?

Answer 11

PLEURAL EFFUSION:
- no output for > 24 hours and imaging shows resolution of the collection.

PNEUMOTHORAX
- no longer bubbling spontaneously/ when patient coughs and imaging shows resolution of the pneumothorax.