Appendix C
Procedural Checklists - Pre-hospital Chest Drain Insertion
| Task |  |
 |
N/A |
|---|---|---|---|
| Examine patient and confirm findings | |||
| Position patient adequately with arm on which drain is to be inserted behind head | |||
| Gather appropriate equipment | |||
| Identify 'safe trinagle' and choose point of insertion above a rib to avoid the neurovascular bundle | |||
| Infiltrate local anaesthetic (maximum 3mg/kg 20ml 1% Plain lignocaine in 70kg adult), initially by drawing up a skin bleb with an orange needle and then using a green needle to infiltrate through the soft tissues onto the rib and pleura aspirating as the needle is advanced | |||
| Maintain asepsis as much as possible | |||
| Clean hands with alcohol gel and don sterile gloves | |||
| Open chest drain pack keeping contents sterile | |||
| Clean the skin using betadine spray | |||
| Make a horizontal incision where the drain is to be inserted. Ensure that this is big enough for the drain (approximately 2-3cm) and goes through all the layers of the skin only | |||
| Using forceps (come with Portex frontline kit) blunt dissect through the subcutaneous tissues (open and close forceps to separate rather than cut tissues. Make sure that you dissect down onto the upper border of the rib and open the pleura (you should feel a sudden give and sometimes a hiss of air or flow of blood) | |||
| Insert a finger into the pleural cavity and sweep round to make sure that the lung is not adhered to the chest wall (CAUTION if the patient has rib fractures as these may puncture your glove) | |||
| Estimate depth of insertion by looking at the markings on the drain and distance from apex of the lung to your incision. All the holes along the length of the drain need to be within the pleural space. | |||
| Insert the drain through the hole in the pleura and into the cavity; aim the drain towards the apex | |||
| DO NOT LET GO OF THE DRAIN until it is safely sutured in place | |||
| Attach the end of the drain onto the closed drainage bag and tubing, make sure air is draining freely | |||
| Insert a stay suture and a close (mattress) suture that can be used to close the wound when the drain is removed. Make sure you use a strong suture like 1.0 silk or it may snap. Ensure that your stay suture is tight and slightly indents the drain | |||
| Secure the drain to the skin using some cut swabs and SLEEK to ensure additional drain security in pre-hospital environment | |||
| Dispose of all waste and sharps appropriately | |||
| Record procedure details, including any complications |
Adapted from L. Malek - SCOTS Project, Procedural Checklists
