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Surgical chest drain insertion
Joshil Lodhia
CT1, Cardiothoracic Surgery
University Hospital of South Manchester
Pre-procedural checks
• Consent
• Clotting
• Assess the CXR prior to insertion
• Indication alters placement (Apically or ...
Equipment
• Chlorhexidine/ Povidone-iodine
• Drapes
• Gloves, gowns, scrub hat, face mask
• 1% Lignocaine 10-20ml (max dos...
Equipment cont…
• Chest drain kit
• 10 blade and handle
• 2x curved clamps
• Scissors
• Chest drain (18-32F depending on i...
Preparation
• Placement
• Patient at 30-45 degrees
• Arm behind his/her head
• Safety triangle
• Anterior border made by t...
Anaesthesia
• Palpate the ribs and infiltrate with 1% ligocaine just above the rib
• Go into pleura above the rib till flu...
Dissection
• Place the closed curved clamp through the incision
• Curve facing down
• Rest on the rib below (dissect above...
Drain placement
• Place a finger into the pleural space
• Sweep 360 degrees to free adhesions and ensure correct placement...
Procedure cont.
• Advance the drain till all the drain holes are in the chest cavity
• Secure the drain with the previousl...
Post-procedural checks
• Re-examine the patient
• Ensure fluid level is swinging
• It may also be bubbling in the presence...
Further tests
• If effusion present send sterile samples for
• MC&S including Acid fast bacilli
• Cytology
• Glucose
• Pro...
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Insertion of a surgical chest drain

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Insertion of a surgical chest drain

  1. 1. Surgical chest drain insertion Joshil Lodhia CT1, Cardiothoracic Surgery University Hospital of South Manchester
  2. 2. Pre-procedural checks • Consent • Clotting • Assess the CXR prior to insertion • Indication alters placement (Apically or basally) • Ensures correct side • Equipment • Giving oral analgesics 20 minutes prior to placement helps optimise pain relief
  3. 3. Equipment • Chlorhexidine/ Povidone-iodine • Drapes • Gloves, gowns, scrub hat, face mask • 1% Lignocaine 10-20ml (max dose: 3 ml/kg) • 10-20ml syringe • 2x green needles • 1x orange needle
  4. 4. Equipment cont… • Chest drain kit • 10 blade and handle • 2x curved clamps • Scissors • Chest drain (18-32F depending on indication) • Gauze • Drain tubing • Underwater seal drainage system • Fill to the mark with sterile water • 1-0 Silk suture • Dressings
  5. 5. Preparation • Placement • Patient at 30-45 degrees • Arm behind his/her head • Safety triangle • Anterior border made by the lateral border of pectoralis major • Posterior border made by the lateral border of latissimus dorsi • Inferior border made by the 5th intercostal space • Scrub, gown, gloves, scrub hat, face mask • Clean skin with prep • Place the drapes
  6. 6. Anaesthesia • Palpate the ribs and infiltrate with 1% ligocaine just above the rib • Go into pleura above the rib till fluid/air is aspirated • Pull back a small amount till it is no longer aspirating and infilatrate further • Wait 5 minutes and ensure adequate anaesthesia • Create an incision the width of your finger/drain
  7. 7. Dissection • Place the closed curved clamp through the incision • Curve facing down • Rest on the rib below (dissect above the rib) • Hold the clamp close to the skin to prevent it slipping too far into the chest • Place the clamp in closed then open to dissect • Close and pull the clamp out and repeat • Continue until into the pleural space • Hear a hiss or obtain fluid. • Open the clamp in that space to create a space.
  8. 8. Drain placement • Place a finger into the pleural space • Sweep 360 degrees to free adhesions and ensure correct placement • Place a holding suture and a vertical mattress suture • The vertical mattress suture is for when the drain is removed • Placing the suture now ensures it does not catch the drain later • Place a clamp on the end of the drain to ensure air does not enter the chest • Place the curved clamp at the tip of the drain to help guidance • Insert the drain • Apex for pneumothoraces • Basally for effusions
  9. 9. Procedure cont. • Advance the drain till all the drain holes are in the chest cavity • Secure the drain with the previously placed holding suture • Attach the drain tubing • Attach the tubing to the underwater system • Release the clamp from the drain and ensure swinging (and bubbling if pneumothorax) • Make a slit in the gauze and place around the drain and apply the dressings
  10. 10. Post-procedural checks • Re-examine the patient • Ensure fluid level is swinging • It may also be bubbling in the presence of a pneumothorax • CXR to ensure correct placement and reassess the lung status
  11. 11. Further tests • If effusion present send sterile samples for • MC&S including Acid fast bacilli • Cytology • Glucose • Protein • LDH • Lactate • pH

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