Chest Drain - fundamentals

Pleural Aspiration –Tension Pneumothorax 2nd intercostal space midclavicular line Use venflon or central line catheter (avoid sharp needle’s) O2 Then arrange for chest drain

“There is no organ in the thoracic or abdominal cavity that has not been pierced by a chest drain.”

Safety Precautions Consent – Written & informed Lignocaine test dose Check & Ensure the side (right or left) of ICD Clinical Examination CXR O2 must be connected SpO2 Monitor

Position-for Pleural aspiration/ Thoracocentesis ONLY

Position - Triangle of safety

Chest Drain Insertion Steps

Chest Drain Insertion Steps…

Underwater Seal Options

Post ICD Care Adequate pain control Ambulate & Chest physiotherapy, O2, Nebulisation…… NEVER Clamp the chest drain – if BPF is persistent –ICD clamping may create tension pneumothorax Assess for air leak on asking to take deep breath or on coughing –confirm NO air leak Chest x-ray ICD column not moving ? Lung is fully expanded Blocked (less likely in 28/32 drain)

When to Remove ICD NO Air leak (BPF has closed) Lung Fully Expanded Assess for air leak on asking to take deep breath or on coughing –confirm NO air leak Lung Fully Expanded Clinically Chest x-ray Drainage is less than 100ml/24hrs