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
6. Chest drain management
7. Chest drain Removal
   1. Procedural Guidelines - Removing a chest drain
8. Risk Factors of Chest Drain Management
9. Theoretical Assessment - Chest Drains
10. Housekeeping
11. Appendices

Procedural Guidelines - Removing a chest drain

Chest drains should only be removed by a practitioner who is trained in the procedure. An assistant must be present to help with wound closure. The decision to remove a chest drain should only be made by a senior

doctor. Administer analgesia 30 minutes prior to the procedure (opiate +/- Local anaesthesia) as this can be a painful procedure (Bruce et al 2006). A Procedural Checklist can be found at Appendix E. This will be of use to you during the simulated practice session

Click here for Appendix E

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

• Explain the procedure to the patient and obtain informed consent.

• Get patient to practise Valsalva manoeuvre (3 deep breaths in and out and then hold the breath at the end of the 4^th inspiration)

• Gather appropriate equipment and open dressing pack

• Ensure patient is lying comfortably with the arm on the side of the drain behind the head

• Administration of oral or intravenous analgesia if not contraindicated (ideally 15 minutes before the procedure)

• Wash hands and put on gloves and apron

• Remove dressing and identify 'stay' and 'close' sutures

• Isolate 'close' suture ready to tie once drain removed

• Clean wound with antiseptic skin preparation such as chlorhexidine

• Cut the 'stay' suture

• Ask the patient to perform the Valsalva manoeuvre and firmly pull out the chest drain and get your assistant to apply pressure over the wound to prevent an air leak

• Clean wound with antiseptic skin preparation such as chlorhexidine

• Tie suture to close wound, not too tightly, apply a few steristrips if necessary

• Apply occlusive dressing

• Perform repeat chest x-ray to make sure that original pathology has not recurred (normally after 1 hour)

• Record procedure, including any complications in the patient's notes

• Regularly check patient's observations and drain site in the hours after chest drain removal