Authors:Â Sukhchain Bansal, Rebecca Zhao, Riad Hosein /Â Editor:Â Lauren Fraser / Reviewer: Ahmad Alabood /Â Codes:Â SLO1, SLO3, SLO6, TC1, TP3Â /Â Published: 13/05/2020 / Reviewed: 12/04/2024
*The mentor who helped with this when Riad was a registrar Mr Manjeet Riyat Consultant at Derby passed away from Covid 19 on 20/04/2020. The last video acknowledges his involvement.
The earliest documentation of a procedure resembling chest drainage in medicine dates back 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 a number of 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.
This module will cover the practical aspects of safe insertion of chest drains.
Chest drains may be broadly divided into two groups:
- Small bore drains inserted via Seldinger technique
- Large bore drains necessitating open insertion
The Seldinger technique has demonstrated a much lower risk of serious complications and also lower pain scores when compared with large bore chest drains. A systematic review comparing the two methods in over 875 patients with pneumothorax found similar success rates but a significantly lower complication rate, shorter drainage duration and hospital stay in the small-bore drainage group. [3] However, in the context of trauma, haemothorax is likely and so a large bore drain with open insertion is preferred.
The following video sessions will cover chest drain equipment and preparation. Make sure you prepare everything in conjunction with a NATSIPP checklist.Â
Introduction and Preparation
Chest Drain Equipment
Chest Drain Bottle
Cleaning, Draping
Incision and Dissection
Insertion of Drain
Anchoring
After care
Equipment
Cleaning, Draping
Procedure
Anchoring
- Hippocrates PP, Sivaramakrishnan K, Swanson KW, et al. Hippocrates Volume VI. Cambridge (MA): Harvard University Press, 1988: 39-43.
- Rapid Response Report: Risks of chest drain insertion Reference NPSA/2008/RRR03
- Chang SH, Kang YN, et al. A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax. Chest. 2018 May;153(5):1201-1212.
41 Comments
Excellent module. Good revision
useful practical informaton
Fantastic module!
The content was helpful and concise. The videos were not long and were presented well. I recommend this module to all clinicians.
Concise/ Video’s were great.
Well explained
great module
Really helpful overview
Very good module , educative and practical.
comprehensive and informative module
Good article
enthusiastic presentation
Excellent comprehensive details of the procedure.
informative and good module
fantastic learning session!
Well put together. Thank you very much.
Nicely done!
very good videos
excellent session
Excellent – extremely useful. Videos and presentation very clear and methodical. Thank you.
excellent presentation for a practical procedure.
Great review of the topic
really helpful guide, especially the videos on securing the drain. thank you very much
Precise and excellent demonstration of procedure and good revision of chest drain. Thank you.
This was very insigtful, engaging and useful
very good sequence of videos with clear description
Excellent review
Very good module , thank you
Excellent overview
It was excellent review and the videos was really informative too.
Thanks. Nice video tutorial.
Really thanks for an excellent module with videos.
Good job
great session
Brilliant, one of the most comprehensive sessions I’ve ever listened to.
Highly recommended.Thanks @RCEMlearning team
very educating videos
Well explained.
Very useful
thank you, useful
Well explained . Great module.
This was a very well put together module