The earliest documentation of a procedure resembling chest drainage in medicine dates to fifth century B.C. with Hippocrates, who pioneered the theory that illness derives from an imbalance in the ‘four humours’ of the body. [1] Thoracic drainage has developed through medical history and chest drain insertion is now well established in the management of pneumothorax, pleural effusion and trauma (to name a few indications), making it an important procedural skill for the Emergency Department physician.

However, this is a procedure which comes with significant risk of complication. In 2008, following several patient safety incidents, the National Patient Safety Agency (NPSA) issued a report alerting the high-risk nature of chest drain insertion. [2] Over a 26-month period the report identified a total of 2,152 patient safety incidents involving chest drains. 12% of these resulted in moderate patient harm, 1% resulted in serious patient harm and 1% in patient death. The NPSA report cites factors including inexperienced doctor, lack of clinician supervision, site of insertion, patient anatomy, equipment, inadequate diagnosis and lack of guidelines. All chest drains should be inserted using a NATSSIP checklist too.

This module will cover the safe insertion of chest drains.

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