Chest drain Flashcards

1
Q

What is the purpose of chest drain insertion?

A

Creates a one-way valve
=> allowing movement of air or liquid out of the cavity.

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2
Q

Give examples of when a chest drain may be indicated

A

Pleural effusion
Pneumothorax
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
penetrating chest wall injury in ventilated patients

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3
Q

In what cases would a chest drain be contraindicated?

A

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

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4
Q

Where is a chest drain inserted anatomically?

A

5th intercostal space in the midaxillary line

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5
Q

Technique used to insert the drainage tube

A

Seldinger technique

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6
Q

How can the position of a chest drain be confirmed?

A
  1. aspiration of fluid from the drainage tubing
  2. ‘swinging’ of the fluid within the drain tubing when the patient inspires
  3. chest x-ray
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7
Q

Complications of chest dranis which must be discussed during consent

A
  • Failure of insertion
  • Bleeding
  • Infection
  • Penetration of the lung
  • Re-expansion pulmonary oedema
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8
Q

When should re-expansion pulmonary oedema be suspected?

A

Usually preceded by the onset of a cough and/or shortness of breath.

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9
Q

What should you do if you suspect re-expansion pulmonary oedema?

A
  1. CLAMP the chest drain
  2. Order urgent CXR
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10
Q

How can we aim to prevent re-expansion pulmonary oedema?

A
  • drain tubing should be clamped regularly if rapid fluid output

i.e. drain output should not be >1L of fluid over 6 hours

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11
Q

When should a chest drain be removed?

A

PLEURAL EFFUSION:
- no output for > 24 hours and imaging shows resolution of the collection.

PNEUMOTHORAX
- no longer bubbling spontaneously/ when patient coughs and imaging shows resolution of the pneumothorax.

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