Risk Assessment
NPSA - Questions to ask yourself before inserting a chest drain
- Does it need to be done?
- Does it need to be done now?
- Am I competent to do this?
- Is supervision available?
- Am I familiar with the equipment?
- Does patient require a large 'trauma drain' with open technique or a smaller drain with Seldinger technique?
- 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
