Chest Drains Online Skills Pack

Table of Contents

1. Chest Drain Programme
2. Essential Pre-requisite Knowledge
3. Large bore chest drain insertion
4. Small-bore chest drain insertion
5. Pre-hospital chest drain insertion
   1. Pre-hospital considerations
   2. Clinical Signs of Tension Pneumothorax
   3. Questions to ask yourself before inserting a pre-hospital chest drain?
   4. Procedural Guidelines - 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

Pre-hospital considerations

It is vitally important in the pre-hospital setting to ensure that chest drains are only inserted by practitioners who are competent in this procedure. In making the decision as to whether or not to insert a chest drain you must balance the risks and benefits of inserting a drain in what is a difficult environment, with limited asepsis and adding delay to transfer for definitive hospital care. In most environments drain insertion should not be performed, rather the patient should be taken to hospital as quickly as possible for chest drain insertion there. e.g. Suspected simple pneumothorax with no respiratory embarrassment is not an indication for chest drain insertion in pre-hospital care. However, in some rural areas where there are significant distances to definitive care then it may be necessary to insert a drain.

Indications:

The only absolute indication for a pre-hospital chest drain is chest pathology causing significant respiratory embarrassment, with hypoxia that will be relieved by drain insertion. Examples include:

• Tension pneumothorax - Not responding to needle decompression
• Tension Pneumothorax - Re-accumulating after needle decompression

Needle decompression of Tension Pneumothorax

• Identify 2^nd intercostal space in mid-clavicular line on affected side of chest
• Clean skin
• Insert large-bore cannula just above rib in 2^nd IC space
• Remove needle and make sure that air either hisses from or can be aspirated from the cannula
• Do not occlude the cannula
• Watch cannula carefully to male sure it does not get occluded or kinked

Note: Tension pneumothorax may be relieved sufficiently well with needle decompression alone, obviating the need for chest drain. In this circumstance the patient should be rapidly transferred to hospital under close observation.