Tube Size

Chest drain sizes range from 8 – 40F in adults; big number = big drain. Large-bore drains (>24F) are recommended for draining blood and require blunt dissection [5].

Smaller bore drains are appropriate for clearly isolated pneumothoraces i.e. no accompanying haemothorax – blood tends to clot within the drain, rendering it useless. Small-bore chest drains may be inserted by Seldinger technique (Fig 1).

Prime the underwater seal with saline (Fig 2) not sterile water, so that the drained blood is available for cell salvage in cases of massive blood loss.

Fig 1: Seldinger kit (click on the image to enlarge)

Fig 2: Use saline not water

Do larger Seldinger chest drains exist?

Yes they do – but inserting them into haemothoraces is not considered as safe as the traditional (blunt dissection) method.

Learning bite

Prime the underwater seal with saline, not sterile water in cases of anticipated significant haemothorax so that the drained blood is available for cell salvage.