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Risk Assessment

NPSA - Questions to ask yourself before inserting a chest drain

  1. Does it need to be done?
  2. Does it need to be done now?
  3. Am I competent to do this?
  4. Is supervision available?
  5. Am I familiar with the equipment?
  6. Does patient require a large 'trauma drain' with open technique or a smaller drain with Seldinger technique?
  7. Is USS available, especially if inserting a drain for fluid?

Contraindications

  • Lung adhered to the chest wall on x-ray
  • Bullous lung disease (caution as what looks like a pneumothorax may in fact be a bulla)
  • Bleeding disorder (relative contraindication if INR raised or platelets low, balanced with degree of urgency of drain insertion)

Best Practice Statement

Unless in an emergency the patient should have a chest x-ray performed before drain insertion

Rationale: Confirm that drain insertion is indicated and confirm side of placement

Source of Evidence: BTS guidelines

Precautions

  • Patients currently receiving anti-coagulant therapy - increased bleeding time post procedure
  • Patients with chronic respiratory problems who may not be able to tolerate lying flat
  • Patients with chronic obstructive pulmonary disease- confirm that an apparent pneumothorax is not a bulla before inserting a drain
  • Patients with a tension pneumothorax should have needle decompression performed prior to insertion of a chest drain

Best Practice Statement

In non-urgent chest drain placement consideration should be given to the use of USS to guide insertion

Rationale: Make sure drain inserted into right area and minimise risk of damage to other structures

Source of Evidence: NPSA