chest drains 2

Question 1

Triangle of safety
Applied anatomy for insertion chest drain
a.) The anterior border 
b.) the posterior border
c.) the inferior border
d.) the triangle has an apex

Answer 1

, (a) The anterior border – lateral
border of Pectoralis Major, (b) the posterior border – anterior
border of Latissimus Dorsi, (c) the inferior border – an imaginary
line running horizontally just inferior to the level of the nipple and
(d) the triangle has an apex within the a-xilla

Question 2

Chest drain insertion is a painful procedure. One study

has shown that

Answer 2

50% of patients experience pain levels of

9–10 out of 10

Question 3

Patient position, asepsis, and antibiotic prophylaxis

Answer 3

An ideal position is with the patient on a bed, sitting up
at an angle of 45, with the arm of the affected side
placed over or behind the head to expose the axillary
region

Question 4

antibiotic prophylaxis

Answer 4

absolute risk of empyema is reduced by 5.5%–7.1%
and all infectious complications by 12.1%–13.4% in
the presence of any chest trauma

Question 5

Stepwise outline for an ICD insertion part 1

Answer 5

1. Appropriate analgesia is given;
2. The area is prepped and draped appropriately to
   maintain an aseptic technique throughout;
3. The site of drain insertion is confirmed;
4. Local anaesthetic is administered at the site of
   drain insertion and surrounding tissue;
5. An incision is made through the skin and subcutaneous fat to accommodate the operator’s finger
6. The track is developed, by blunt dissection only,
   using a closed clamp;

Question 6

Stepwise outline for an ICD insertion part 2

Answer 6

7. The dissection is further developed over the rib
   until the pleura is breached;
8. A finger is inserted into the pleural cavity and a
   finger sweep is carried out;
9. An appropriately sized chest tube is mounted onto
   the clamp and passed through the track into the
   pleural cavity;
10. The end of the tube is connected to an underwater
    seal;
11. The drain is secured in place;
12. An appropriate suture is placed around the incision
    to approximate the tissue on drain removal and the
    drain is sutured in place;
13. Clinical signs are checked to confirm effect; and
14. A chest radiograph is obtained to confirm drain
    position and effect.
    Alternative drain positi

Question 7

Alternative drain positions

Answer 7

Persistent apical pneumothoraces can be drained by
an anterior ICD placed in the second intercostal
space in the mid-clavicular line

Question 8

Drain size

Answer 8

Large bore drains are preferred to avoid the incidence of drain blockage from thick, malignant or
infected fluid
t smaller bore
tubes should be used for drainage of pneumothoraces
whilst large bore tubes

Question 9

Position of the drain tip

Answer 9

the drain tip is
aimed at the apex of the thoracic cavity, whereas with
fluid it should be aimed basally.

Question 10

Securing the drain

Answer 10

1/0 silk is ideally used for securing the drain. Once
inserted, the drain should be secured immediately
using a stay suture to secure the drain and avoid it
becoming malpositioned or slipping out.
A second suture, preferably a series of mattress
sutures, should be placed to allow the wound to be
closed on drain removal. A ‘purse string’ suture
should be avoided as this may leave an unsightly scar
and is likely to be more painful.