Chest Drain

Question 1

What is a chest drain?

Answer 1

A tube inserted into the pleural cavity which creates a one-way valve, allowing movement of air or liquid out of the cavity.

Question 2

What are the indications of chest drain insertion?

Answer 2

Pleural effusion
Pneumothorax nor suitable for conservative management or aspiration
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
In some cases of penetrating wall injury in ventilated patients

Question 3

What are contraindications to chest drain insertion?

Answer 3

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
(Relative to situations)

Question 4

Once consented and imaging assessed, how should a chest drain be inserted?

Answer 4

Supine position at 45o angle. 
Forearm behind head
5th intercostal space, midaxillary line
Lidocaine
Tube inserted

Question 5

What are some complications of chest drain insertion?

Answer 5

Failure
Bleeding
Infection
Penetration of the lung
Re-expansion pulmonary oedema (onset of cough or SOB - clamp drain and x-ray)

Question 6

When should the chest drain be removed?

Answer 6

No output for 24 hours, and resolution of the fluid collection on imaging.
Pneumothorax - no bubbling on cough or imaging shows resolution.

Question 7

When are larger bore chest drains indicated?

Answer 7

Trauma and haemothorax

Question 8

When are smaller diameter chest drains indicated?

Answer 8

Pneumothorax or pleural effusion drainage

Question 9

What are the two potential places of chest drain insertion?

Answer 9

Mid axillary line, 5th intercostal space.

Traingle of auscultation on back.