Chest Drain Flashcards
What is a chest drain?
Tube inserted into pleural cavity which creates a 1-way valve allowing air or liquid out
List 6 indications for a chest drain
Pleural effusion
Pneumothorax
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
Give 4 relative contraindications to chest drain insertion
INR >1.3
Platelet count <75
Pulmonary bullae
Pleural adhesions
Describe insertion of a chest drain
- Patient forearm behind head
- Identify safe triangle in 5th ICS MAL +/- US guidance
- Anaesthetise with Lidocaine
- Insert tube using Seldinger technique
- Secure tube with stitch/ adhesive dressing
What are the borders of the safe triangle
Anterior edge Latissimus dorsi
A line superior to the horizontal level of the nipple
Lateral border of Pectoralis major
Apex below the axilla
How can positioning of a chest drain be confirmed?
Aspiration of fluid from drainage tube
Swinging of fluid within drain tubing when patient inspires
CXR
List 5 complications of chest drain insertion
Failure of insertion
Bleeding: around site or into pleural space
Infection
Penetration of the lung
Re-expansion pulmonary oedema
What may re-expansion pulmonary oedema be preceded by?
Cough
SOB
What action should be taken if re-expansion pulmonary oedema is suspected?
Clamp the drain
Urgent CXR
How can re-expansion pulmonary oedema be avoided?
Regularly clamp drain in the event of rapid fluid output
Output should not exceed 1L/6h
In cases of fluid drainage from the pleural cavity, when should the drain be removed?
When there has been no output for >24h + imaging shows resolution of collection
In cases of pneumothorax when should the chest drain be removed?
When it is no longer bubbling spontaneously or when the patient coughs
+ ideally when imaging shows resolution of the pneumothorax
