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

Procedural Guidelines - Chest Drain Insertion Generic Aspects

An equipment list is available at Appendices F & G and a Procedural Checklist can be found at Appendices A & B. These will be of use to you during the simulated practice session.

Click here for Appendix F

Click here for Appendix G

Click here for Appendix A

Click here for Appendix B

• Introduce yourself to the patient. Ensure that you have the correct patient by checking name, date of birth and CHI against arm band and notes

• Examine the patient's chest and confirm clinical findings. CONFIRM SIDE ON WHICH DRAIN IS TO BE INSERTED ON BOTH PATIENT AND X-RAY

• Explain the procedure to the patient and obtain informed consent. Check for allergies (NPSA recommends that written consent should be obtained where possible)

• Gather appropriate equipment and select chest drain size (12F small bore 32F large bore). DO NOT SELECT A DRAIN THAT HAS A METAL TROCHAR

• Ensure patient is lying comfortably with the arm on the side on which the drain is to be inserted behind the head (alternatively if the drain is to remove fluid or pus the patient may sit upright leaning over a pillow or table)

• Identify the 'SAFE TRIANGLE' and choose point of insertion above a rib to avoid the neurovascular bundle

• Infiltrate local anaesthetic (maximum 3mg/kg, 10ml 1% Plain lignocaine in 70kg adult is usually sufficient), initially by drawing up a skin bleb with an orange needle and then using a green needle to infiltrate through the soft tissues onto the rib and pleura aspirating as the needle is advanced

• Administer analgesia (Intravenous Morphine titrated to effect) unless contra-indicated and consider use of an anxiolytic (Midazolam 1-2mg titrated to effect with caution as can cause respiratory depression)