Both techniques are low- risk in experienced hands. However, the National Patient Safety Agency has issued specific recommendations following reports of 12 deaths and 15 cases of serious harm associated with drain insertion between 2005 and 2008, most attributed to the dilator/trochar [18].

Recognised complications include:

  • Drain blockage (8.1%)
  • Malposition (0.6%)
  • Empyema (0.2%)
  • Injury (0.2%) – visceral (lung, heart, liver, spleen), nerve (intercostal, long thoracic or sympathetic (Horner’s syndrome)), artery (lateral thoracic, internal mammary)
  • Re-expansion pulmonary oedema R.P.O 0.6%

Learning bite

Chest drain insertion is potentially dangerous.
Twenty seven cases of death or serious harm were reported as a result of chest drain insertion in the UK between 2005 and 2008. This is probably a conservative figure. This procedure should only be performed by a person trained and signed off as competent to do so.