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

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