Appendix A
Procedural Checklists - Large-Bore Chest Drain Insertion
| Task |  |
 |
N/A |
|---|---|---|---|
| Introduce self to patient by name and title | |||
| Ensure you have the correct patient - check name, DOB, CHI (in-patients) or address (primary care) or Typenex number (unknown identity)* | |||
| Confirm side of drain insertion on patient and x-ray | |||
| Gather appropriate equipment (Appendix F) | |||
| Explain procedure to patient | |||
| Gain verbal +/- written consent | |||
| Position patient appropriately | |||
| Identify safe triangle and point of insertion within triangle above a rib | |||
| Consider Oxygen, analgesia, anxiolytic | |||
| Infiltrate local anaesthetic 3mg/kg max (skin bleb, then down onto rib) | |||
| Asepsis -hand wash, sterile gloves, mask, gown | |||
| Get assistant to open chest drain pack-keep contents sterile | |||
| Take suture, drain, scalpel, antiseptic skin cleanser and underwater seal system from assistant | |||
| Clean skin with chlorhexidine and swabs | |||
| Apply drapes to maintain sterile field | |||
| 2-3cm incision parallel to rib through all layers of skin | |||
| Insert stay and close sutures and clip to drapes | |||
| Blunt dissect with forceps until down to rib, open pleura | |||
| Perform a finger sweep to make sure lung not adherent | |||
| Estimate depth of insertion on markers on drain | |||
| Insert drain, with plastic introducer if preferred, aiming for apex up to required marker | |||
| Remove introducer and place thumb over end of drain | |||
| Keep hold of drain and attach to underwater seal system | |||
| Place drainage system below patient and make sure it is bubbling or swinging | |||
| Tie in place making sure stay suture slightly indents the drain | |||
| Remove drapes | |||
| Secure drain to the skin using swabs and dry dressing | |||
| Dispose of all waste and sharps appropriately | |||
| Obtain a chest x-ray to confirm position | |||
| Record procedure details, including any complications in the patients notes |
Adapted from L. Malek - SCOTS Project, Procedural Checklists
