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

Clinical Signs of Tension Pneumothorax

• Trachea deviated away from affected side
• Absent air entry on affected side
• Hyper-resonance on affected side
• Distended neck veins
• Signs of pneumothorax and patient severely compromised i.e. haemodynamic and respiratory failure

Obviously a chest x-ray prior to drain insertion will not be available so good clinical examination and judgement is vital. Inserting a drain pre-hospital is high risk as the procedure will be carried out in a less than adequate environment. It is important to think about the anatomy of the chest wall and its landmarks whilst exposing and positioning the patient optimally. Ensure that the site for insertion is in the safe triangle and not too low with the risks of damage to the liver and spleen. Remember that the anatomy can be even more difficult to identify in obese patients.

Note: the 4^th and 5^th intercostal spaces are higher than you think they will be and normally lie just below axillary fold

Try to maintain asepsis as much as possible, although the compromise may be an antiseptic skin spray such as BETADINE, sterile gloves and a dressing pack. Ensure that a trained paramedic or similar practitioner is able to assist with the procedure. Always make sure that the drain is firmly sutured in place so it does not dislodge during transfer to hospital.

The biggest pre-hospital modification is that an underwater seal drainage system will not be available. The compromise is to attach a drainage bag, similar to a urine bag, with a one-way valve that will allow blood or fluid to escape from the pleural space.