Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Chest drain insertion
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Definition
A chest drain is a conduit for the removal of air or fluid from the pleural cavity. Three components are required: the chest drain itself, a container for collection (placed below the level of the chest) and a valve mechanism such as an underwater seal or Heimlich valve.
Indications
Pneumothorax (especially in ventilated patients)
Traumatic haemopneumothorax
Postoperative – e.g. thoracotomy, oesophagectomy, cardiac surgery
Large malignant pleural effusions
Empyema and complicated parapneumonic pleural effusion.
Pre-procedure considerations
▪ Obtain a pre-procedure chest X-ray except in the case of tension pneumothorax, and confirm site/side.
▪ Consider risks: correct any coagulopathy where possible, take care with differential diagnosis of pneumothorax and bullous disease.
▪ Drainage of a post-pneumonectomy space should only be carried out after consultation with a cardiothoracic surgeon.
▪ Explain the procedure and obtain patient consent.
▪ Consider premedication (opiate or benzodiazepine) if patient conscious.
▪ Consider image guidance if unable to aspirate free air/fluid with a needle.
▪ Prophylactic antibiotics e.g. a cephalosporin should be given in trauma cases.
▪ Prepare equipment including chest drain set, sterile preparation, local anaesthetic, underwater seal drain, silk suture, scalpel, dressings and pulse oximeter.
Procedure
▪ Position the patient correctly – either on a bed, hand behind head on the side of insertion to expose the axilla, upright leaning over a table with a pillow or in the lateral decubitus position. Patient should be on oxygen and have peripheral access.
▪ Identify the site – fifth intercostal space in the mid-axillary line, above the rib to avoid the neurovascular bundle.
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- Type
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- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 622 - 625Publisher: Cambridge University PressPrint publication year: 2009