BTS guidelines for the insertion of a chest drain

Box 1 Indications for chest drain insertion Pneumothorax in any ventilated patient tension pneumothorax after initial needle relief persistent or recurrent pneumothorax after simple aspiration large secondary spontaneous pneumothorax in patients over 50 years Malignant pleural effusion Empyema and complicated parapneumonic pleural effusion Traumatic haemopneumothorax Postoperative-for example, thoracotomy, oesophagectomy, cardiac surgery 4 PRE-DRAINAGE RISK ASSESSMENT Risk of haemorrhage: where possible, any coagulopathy or platelet defect should be corrected prior to chest drain insertion but routine measurement of the platelet count and prothrombin time are only recommended in patients with known risk factors. Sterile gloves and gown Skin antiseptic solution, e.g. iodine or chlorhexidine in alcohol Sterile drapes Gauze swabs A selection of syringes and needles (21-25 gauge) Local anaesthetic, e.g. lignocaine (lidocaine) 1% or 2% Scalpel and blade Suture (e.g. "1" silk) Instrument for blunt dissection (e.g. curved clamp) Guidewire with dilators (if small tube being used) Chest tube Connecting tubing Closed drainage system (including sterile water if underwater seal being used) Dressing Equipment may also be available in kit form. 6.