Chest drain

Question 1

indications?

Answer 1

Pleural effusion
Pneumothorax not suitable for conservative management or aspiration
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
In some cases of penetrating chest wall injury in ventilated patients

Question 2

contra-indications?

Answer 2

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

Question 3

location?

Answer 3

safe triangle
The triangle is located in the mid axillary line of the 5th intercostal space. It is bordered by:
Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line superior to the horizontal level of the nipple, and the apex below the axilla.

Question 4

complications?

Answer 4

1. failure of insertion
2. bleeding
3. infection
4. penetration of lung
5. re-expansion pulmoanry oedema

Question 5

how does re-expansion pulmonary oedema present?

Answer 5

onset of cough

SOB

Question 6

management of re-expansion pulmonary oedema?

Answer 6

clamp the chest drain

order urgent chest x-ray

Question 7

how can you prevent this?

Answer 7

clamp drain tubing regularly in the event of rapid fluid output (drain output should not exceed 1L of fluid over a short period of time ? <6hrs)