Chest Drains And Thoracostomies

Question 1

Where is the correct position and landmarks for a chest drain?

Answer 1

5th inter coastal space in the mid axillar line, between the safe space: lateral edge of pectoris major and lateral edge of latissimus dorsi, base of axils and 5th intercostal space

Question 2

Should you sedate someone if they are going to insert a chest drain?

Answer 2

Yes, with IV benzodiazepines and opiates

Question 3

Why does a chest drain get inserted into a patient?

Answer 3

To allow for the drainage of air or blood from the pleural space to restore haemodynamic and respiratory stability by optimising ventilation/perfusion and minimising mediastinal shift

Question 4

What equipment do you need to get ready for a chest drain insertion?

Answer 4

Sterile gloves
Gown
Sterile drape
Chlorhexidine
Theatre light
Sedation/analgesia
Scalpel
Spencer wells forceps
Underwater seal drain
Sterile water
Tubing
Suture
Tegaderm dressings

Question 5

What is important when caring for a patient that has had a chest drain inserted?

Answer 5

Ensure the drain remains swinging with respiration
Monitor comfort of patient
Any mass blood loss
No longer bubbling

Question 6

What is a thoracostomy?

Answer 6

Small incision of the chest wall

Question 7

Why would a patient require a thoracostomy?

Answer 7

Treatment of a pneumothorax

Question 8

What do you need to do to set up for a thoracostomy and chest drain?

Answer 8

Make sure the procedure has been explained and gained consent
Local anaesthetic should be available
Analgesia given - sedation!
Equipment all available

Question 9

What do you needed to assess for with a chest drain?

Answer 9

Is it swinging?
Is it bubbling?
How much blood has been drained?

Question 10

How is chest tube placement confirmed?

Answer 10

CXR

Question 11

What is an indication for using chest drain suction?

Answer 11

To help the lung re-expand after draining, only after discussion with thoracic surgeons