Chest Drain

Question 1

What is a chest drain?

Answer 1

A tube inserted into the pleural cavity which creates a one-way valve, allowing movement of air or liquid out of the cavity.

Question 2

List the indications for chest drain insertion.

Answer 2

• Pleural effusion
• Pneumothorax not suitable for conservative management or aspiration
• Empyema
• Haemothorax
• Haemopneumothorax
• Chylothorax
• Penetrating chest wall injury in ventilated patients

Question 3

What are the relative contraindications for chest drain insertion?

Answer 3

• INR > 1.3
• Platelet count < 75
• Pulmonary bullae
• Pleural adhesions

Question 4

True or False: All contraindications for chest drain insertion are absolute.

Answer 4

False

Question 5

What positioning is recommended for a patient prior to chest drain insertion?

Answer 5

Supine position or at a 45º angle, with the forearm positioned behind the head.

Question 6

What guidance does the British Thoracic Society provide regarding ultrasound?

Answer 6

Strongly recommends the use of ultrasound guidance in all cases of fluid within the pleura.

Question 7

What local anaesthetic is used during chest drain insertion?

Answer 7

Lidocaine, up to 3mg/kg.

Question 8

What technique is used for inserting the drainage tube?

Answer 8

Seldinger technique.

Question 9

How can positioning of the chest drain be confirmed?

Answer 9

• Aspiration of fluid from the drainage tubing
• ‘Swinging’ of the fluid within the drain tubing during inspiration
• Chest x-ray

Question 10

List potential complications of chest drain insertion.

Answer 10

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

Question 11

What should be done if re-expansion pulmonary oedema is suspected?

Answer 11

Clamp the chest drain and obtain an urgent chest x-ray.

Question 12

Fill in the blank: Chest drain output should not exceed _______ of fluid over a short period of time.

Answer 12

1L

Question 13

When should a chest drain be removed in cases of fluid drainage from the pleural cavity?

Answer 13

When there has been no output for > 24 hours and imaging shows resolution of the fluid collection.

Question 14

When should a chest drain be removed in cases of pneumothorax?

Answer 14

When it is no longer bubbling spontaneously or when the patient coughs, ideally when imaging shows resolution.

Question 15

What is the ‘safe triangle’ for chest drain placement?

Answer 15

Located in the mid axillary line of the 5th intercostal space, bordered by:
* Anterior edge latissimus dorsi
* Lateral border of pectoralis major
* A line superior to the horizontal level of the nipple
* Apex below the axilla

Question 16

Describe the triangle of auscultation.

Answer 16

Situated behind the scapula, bounded by:
* Above by trapezius
* Below by latissimus dorsi
* Laterally by the vertebral border of the scapula
* Floor partly formed by rhomboid major.