Chest Drains Online Skills Pack

Table of Contents

1. Chest Drain Programme
2. Essential Pre-requisite Knowledge
   1. Introduction
   2. Indications
   3. Potential Indications
   4. Anatomy and Physiology
   5. Risk Assessment
   6. Psychological considerations
   7. Risk Factors
   8. Procedural Guidelines - Chest Drain Insertion Generic Aspects
3. Large bore chest drain insertion
4. Small-bore chest drain insertion
5. Pre-hospital chest drain insertion
6. Chest drain management
7. Chest drain Removal
8. Risk Factors of Chest Drain Management
9. Theoretical Assessment - Chest Drains
10. Housekeeping
11. Appendices

Introduction

Chest drains are inserted into the pleural cavity to remove air or fluid. They are used in many different clinical areas such as

• In a trauma patient in the Emergency Department a chest drain may be used to remove blood or air from the pleural cavity or decompress a Tension Pneumothorax
• In a patient with lung cancer in the Respiratory ward a chest drain may be used to drain a malignant pleural effusion

Therefore doctors, nurses and allied health professionals throughout many settings need to be able to either insert or care for chest drains safely and competently.

This multi-professional chest drain pack is designed for different levels of competencies as required within your clinical environment and scope of professional practice. The competencies that can be selected from this pack are that of

• Large bore chest drain insertion including pre-hospital insertion
• Small bore chest drain insertion using Seldinger technique
• Management, including removal of a chest drain

This pack does not cover the insertion of or on-going management of chest drains in children as this is a highly specialised area of practice.

[D]

Figure 1. Large bore chest drains on x-ray in patient with multiple rib fractures and surgical emphysema

Chest drain insertion has been shown to be associated with 3% early and 8% late complications. Also a recent report (May 2008) from the National Patient Safety Agency (NPSA) has highlighted some of the risks associated with chest drain insertion. They report 12 deaths directly related to chest drain insertion between 2005 and 2008 in England. Some of these deaths were due to damage caused to major structures such as the heart and liver during chest drain insertion. Other adverse events such as inappropriate clamping of the drain can be related to poor chest drain management. Despite these clear risks, the procedure is performed unsupervised by junior doctors. In a large questionnaire of trainees 25% of doctors inserted a first chest drain without supervision (Wong et al 2009).