Chest Drain Insertion: A practical guide

Authors: Sukhchain Bansal, Rebecca Zhao, Riad Hosein / Editor: Lauren Fraser / Codes: C3AP1a, CAP6, CMP2, CMP3, CMP5, HAP6, HAP7, HMP2, HMP3, HMP4, SLO1, SLO3, TP3 / Published: 13/05/2020

*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. My 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:

  1. Small bore drains inserted via Seldinger technique
  2. 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

Introduction and Preparation

Chest Drain Equipment

Chest Drain Bottle

Cleaning, Draping

Incision and Dissection

Insertion of Drain


After care


Cleaning, Draping



  1. Hippocrates, (Potter P, trans.). Hippocrates Volume VI. Cambridge (MA): Harvard University Press, 1988: 39-43.
  2. Rapid Response Report: Risks of chest drain insertion Reference NPSA/2008/RRR03
  3. Chang, S., Kang, Y., Chiu, H. and Chiu, Y. (2018). A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax. Chest, 153(5), pp.12011212.


  1. leea says:

    Excellent module. Good revision

  2. kandaratnami5783 says:

    useful practical informaton

  3. Dr. Abey Oommen says:

    Fantastic module!

  4. Alexander Gaetos says:

    The content was helpful and concise. The videos were not long and were presented well. I recommend this module to all clinicians.

  5. Umar Bhatti says:

    Concise/ Video’s were great.

  6. Ajaz Amin Qasba says:

    Well explained

  7. Dr. Samah Aweis says:

    great module

  8. Chelcie Leigh Jewitt says:

    Really helpful overview

  9. Dr. Moustafa Mohamed Badr Omar Abouelkheir says:

    Very good module , educative and practical.

  10. Bassem Alhadi says:

    comprehensive and informative module

  11. Dr. Javaid Iqbal says:

    Good article

  12. Dr. Ibrahim Abdo Mohammed Hussein says:

    enthusiastic presentation

  13. Dr. Syed Khurram Sibtain says:

    Excellent comprehensive details of the procedure.

  14. Miss Louise Clare Davitt says:

    informative and good module

  15. Andrew Johnston says:

    fantastic learning session!

  16. Obosa Iyamu says:

    Well put together. Thank you very much.

  17. Dr. Sasan Már Nobakht says:

    Nicely done!

  18. Dr. Jhalakkumar Prakashchandra Patel says:

    very good videos

  19. Kevin Breitsprecher says:

    excellent session

  20. Theresa Barron says:

    Excellent – extremely useful. Videos and presentation very clear and methodical. Thank you.

  21. Mrs. Louise Edna Madden says:

    excellent presentation for a practical procedure.

  22. Dr Carolyn Mary Lewis says:

    Great review of the topic

  23. Dr. Alasdair Duncan Donald McFadyen says:

    really helpful guide, especially the videos on securing the drain. thank you very much

  24. Dr Shrinivasa Hangala Lakshmana says:

    Precise and excellent demonstration of procedure and good revision of chest drain. Thank you.

  25. Dr Motunlayo Ayoola Falade says:

    This was very insigtful, engaging and useful

  26. Mr Michael Davey says:

    very good sequence of videos with clear description

  27. Christopher Roots says:

    Very good module , thank you

  28. MIrjana Starinac-Baldwin says:

    Excellent overview

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