ROYAL VICTORIA HOSPITAL THORACIC SURGERY

PROTOCOL FOR INSERTION AND MANAGEMENT OF CHEST DRAINS

Over recent years there have been changes in the types of chest drains available to doctors for the drainage of pneumothoraces and pleural effusions. This document is an attempt to bring you up to date with what equipment is available, to standardise the equipment used around the Royal Victoria Hospital and to advise on safe techniques for their insertion.

All doctors should be able to insert a chest drain in an emergency. Being a surgical procedure elective drains should be inserted either by a surgeon, under the supervision of a surgeon or by another medical practitioner who has been trained and has adequate experience at inserting chest drains. As any complications of the drain insertion will need to be managed by the Thoracic surgeons, it is worthwhile to consider asking them for an opinion on the suitability for a drain and where it should be placed (see below). At times it may be more appropriate to perform a thoracoscopy or other procedure in the first instance rather than contaminating the pleura with a drain.

  • Elective insertion technique
  • Emergency insertion
  • Chest drainage systems
  • Triangle of safety
  • Positioning of chest drains
  • Trocars, clamps and suction
  • Pleural aspiration kits
  • Chest drain insertion packs
  • Removal of chest drains
  • When to call a Thoracic Surgeon
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    1. An American view on treating primary and secondary pneumothoraces, recognising there is a difference, not favouring aspiration as a useful technique and, to my mind, a bit too enthusiastic about surgery in secondary pneumothorax.
      • Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, Luketich JD, Panacek EA, Sahn SA; AACP Pneumothorax Consensus Group. Chest 2001 Feb;119(2):590-602
    2. A British view of pneumothorax guidelines, not distinguishing primary from secondary, favouring aspiration as the first line of management and not recognising the need for surgery.
      • Guidelines for the management of spontaneous pneumothorax. AC Miller & JE Harvey on behalf of the Standards of Care Committee of the British Thoracic Society: Br Med J 1993; 307:114-116
    3. A Belfast view of treating pneumothoraces

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