Authors: Sukhchain Bansal, Rebecca Zhao, Riad Hosein / Editor: Lauren Fraser / Codes: C3AP1a, CAP6, CMP2, CMP3, CMP5, HAP6, HAP7, HMP2, HMP3, HMP4 / 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 . 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 . 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 . 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.
Introduction and Preparation
Chest Drain Equipment
Chest Drain Bottle
Incision and Dissection
Insertion of Drain
- Hippocrates, (Potter P, trans.). Hippocrates Volume VI. Cambridge (MA): Harvard University Press, 1988: 39-43.
- Rapid Response Report: Risks of chest drain insertion Reference NPSA/2008/RRR03
- 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.