| Task
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N/A
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| Introduce self to patient by name and title
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| Ensure you have the correct patient - check name, DOB, CHI (in-patients) or address (primary care) or Typenex number (unknown identity)*
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| Gather appropriate equipment (Appendix G)
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| Explain procedure to patient
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| Gain verbal +/- written consent
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| Position patient appropriately
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| Identify safe triangle and point of insertion within triangle above a rib
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| Consider Oxygen, analgesia, anxiolytic
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| Infiltrate local anaesthetic 3mg/kg max (skin bleb, then down onto rib)
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| Asepsis -hand wash, sterile gloves, mask, gown
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| Get assistant to open chest drain pack-keep contents sterile
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| Take betadine and underwater seal system from assistant
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| Clean skin with betadine and swabs
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| Apply drape to maintain sterile field
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| Make 3-5mm horizontal incision through all layers of skin
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| Insert needle attached to syringe towards upper border of rib (without excess force), aspirating continuously until air or fluid confirms position in pleural cavity
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| Remove the syringe and insert the guide wire keeping one hand on the wire at all times
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| Remove the needle and feed the first dilator onto the wire and through the chest wall into the pleural cavity (it may be necessary to extend the incision slightly at this stage / ensure that dilator is inserted no deeper than required to dilate chest wall)
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| Repeat process for second dilator if present
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| Remove dilator keeping wire in place, estimate depth of insertion of drain using scale
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| Feed the 12F chest drain onto the wire and into the pleural cavity up to desired depth
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| Remove wire keeping one hand on the drain now at all times
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| Keep hold of drain and attach to underwater seal system
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| Place drainage system below patient and make sure it is bubbling or swinging
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| Remove drapes
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| Secure drain to the skin using swabs and dry dressing
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| Dispose of all waste and sharps appropriately
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| Obtain a chest x-ray to confirm position
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| Record procedure details, including any complications in the patients notes
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