This document provides a checklist for inserting a chest drain using Google Glass. It outlines the five main domains of preparing and administering local anesthetic, setting the Seldinger kit, inserting the drain, securing the drain, and cleaning and checking a chest x-ray. The checklist provides detailed steps for each part of the procedure and includes warnings to take special care to stay in the safe triangle and ensure the guide wire is held at all times. Completing the checklist is recommended to properly insert a chest drain using an augmented reality device like Google Glass.

1. Chest Drain Checklist for
GoogleGlass
Beta Version 8
Authors: Tudor Toma, University Hospital Lewisham & Greenwich,
London, UK.
Open Source: please use and quote this source; please contribute
with feedback.
Methods: review of pre-published guidelines, beta versions,
formation of an expert panel and repeat pilot-testing with
googleglass on a simulator
Methodological Reference:
Int J Qual Health Care. 2008;20(1):22-30.
Please email your comments to ttoma@doctors.org.uk

2. Settings
• Prism: adjust
• Tap once to next steps
• Slide finger for forward
• Read then do
• Questions: ask

3. Five Main Domains
Prepare & Local anaesthetic
Set Seldinger
Insert drain
Secure
Clean & Check CXR

4. Warnings! One.
• Always use ultrasound
• Stay in safe triangle

5. Warnings! Two.
• Skin incision: cut only skin
• Dilator does not dilate skin
• Perpendicular direction to pleura
• Measure distance to pleura with ultrasound

6. Warnings! Three.
• Large patients - longer needle for anaesthetic
• Visualize your actions beyond skin

7. Very serious warnings!
• No aspirate? Stop
• Go perpendicularly, or call for help
• Keep a hand on the guide wire at all times

8. Start procedure
• Please follow the checklist

9. Prepare yourself and patient
• Indications: check.
• Drain necessary?
• Clotting (<1.5) & platelets (>90): check
• Info: explain
• Consent

10. Check equipment.
Set trolley.
• Betadine. Dressing. Gown. Gloves
• Drape. Lignocaine. Suture. Mefix
• 2-3 10ml syringes. 2 orange 3 green needles
• Large syringe-cytology. Specimen bottles.
• Seldinger pack. Drain bottle. Sterile water.

11. Finalise preparations
• Bottle: fill
• Patient: set. All sterile
• Seldinger pack: do not open
• Sharps: beware of injuries

12. Local anaesthetic
• Skin: clean; orange-infiltrate.
• Below skin & around pleura: infiltrate. Green
needle.
• Aspiration from the pleural space?
• Do not inject pleural fluid.
• Remember direction and depth

13. Set Seldinger pack in the order of use
1. Scalpel
2. Needle: attach to syringe
3. Wire: blue tip off. Set dilator
4. Drain: remove stiffener
5. Tap: off. Check attachment

14. Insert drain
• Proceed

15. Skin incision & insert needle
• Skin: cut 0.5 cm. Insert needle
• Keep direction like green needle
• Advance- Aspirate –Advance
• When fluid/air advance further 1cm
• Free aspiration: check

16. Insert wire
• Remove syringe
• Thumb over needle
• Insert wire. Half length
• Remove needle
• Hold wire at all times

17. Insert Dilator
• Thread dilator on wire
• Hold wire at all times
• Advance by twisting-spiraling
• Advanced estimated depth only

18. Thread the drain
• Remove dilator, keep wire
• Hold wire at all times
• Thread drain by twisting spiraling
• Hold wire at all times
• Insert 15cm

19. Remove guide wire
• Remove wire
• Wire outside chest? Check - Check
• 3-way tap: attach

20. Secure & Connect the drain
• Proceed

21. Suture
• Skin: 2 cm needle bite
• Skin other side: come down 2 cm bite.
• Tie flat to the skin.
• Secure drain: crossover, double knots
• Check fixation

22. Connect drain to bottle
• Cut & place a gauze
• Secure gauze with tape
• Connect drain to bottle
• Aspirate more fluid/samples

23. Set a plan
• 1.5 litre then clamp
• Iatrogenic pneumothorax and a clamped
drain?
• Reopen after 4h
• Free drainage for slower flows

24. Clean & check the CXR
• You only dispose ALL sharps
• Clean bed space
• Check swinging

25. Document & Check
• Document procedure
• Label & send fluid
• CXR. Check the CXR
• Check drain position and swinging
• Communicate to nurse & docs

26. Procedure Finished
• Document in your log book
• Follow up patient