How to Assess a Chest Drain

Although as an FY1/2 you wouldn’t be expected to insert a chest drain yourself but you will often be called out of hours to review a drain for a variety of reasons:

  • Not swinging/bubbling
  • Not draining
  • Painful
  • “It needs flushed and I don’t do that”
Indications for a chest drain: (BTS guidelines)
  • Tension pneumothorax or large symptomatic pneumothorax
  • Large pleural effusion 
  • Pleuradesis
  • Post thoracoscopy/surgery
  • Empyema

How to assess a chest drain:

1. Look at the patient

Are they comfortable or are they in distress?

If they are distressed you are likely to need senior help, don’t be afraid to ask

2. Look at the drainage bottle

Is there fluid in it? 

What does it look like? 

How much is there? 

How quickly is it coming?

Are their bubbles in the bottle? Get the patient to cough and if there is an air leak you will always see bubbles

Is the fluid in the chamber swinging? Getting the patient to take a deep breath can help to assess this.

Depending on where you work the bottles will likely look like the examples below. Ensure you familiarise yourself with what your local trust has

Rocket
Rocket
Thopaz 1
Thopaz
3. Look at the tubing

Is the fluid swinging?

Is it clamped?

Is there a 3-way tap? Is it open or closed?

4. Assess the drain site

Does it look like its moved?

Is it leaking?

5. Palpate the chest

Is there surgical emphysema? (it feels like bubble wrap)

6. Listen to the chest
7. Get a CXR
8. If you feel comfortable and there is a 3-way tap you can always flush the drain if you think it might be blocked.

Use 20ml sterile 0.9% Saline.

Once you have done these things you can either work out what the problem is or have the knowledge to be able to ask a senior for help, even if its just on the phone for advice

Problems you may come across:

Drain has become dislodged

Depending on the indication for the chest drain this could be life threatening

If you think it needs to be replaced please call a senior to help

Drain is no longer draining fluid
  • Is this because it is dislodged?
  • Is the drain blocked?
  • Was it clamped earlier and this has not been released?
  • Has the effusion drained completely?
Drain is no longer bubbling
  • Is this because it is dislodged?
  • Is it because the pneumothorax has resolved?
  • Is the drain even meant to be bubbling? 
Drain is no longer swinging

A drain should always be swinging.

  • Is this because it is dislodged?
  • Is it blocked?
  • Is it clamped?

Further Reading

Written by Amelia Cutts, Medical/ICM SpR

How useful was this post?

Click on a star to rate it!

Average rating 3 / 5. Vote count: 1

No votes so far! Be the first to rate this post.

As you found this post useful...

Follow us on social media!

We are sorry that this post was not useful for you!

Let us improve this post!

Tell us how we can improve this post?

Related Posts

image1
CT Chest Interpretation
In the webinar below, Dr Dexter Valencia (interventional radiology...
Tachyarrhythmias
Tachyarrhythmias
Tachyarrhythmias are abnormal heart rhythms with a pulse rate...
Medical Education
How to set up a teaching programme
In this guide, we’ll walk you through how to set up local,...

Leave a Comment

Your email address will not be published. Required fields are marked *

Follow us

Favourites

Newsletter

Trending Now

Doctor's Pay Calculator 2024
We’ve created a pay calculator to help you better understand your salary, how much tax you’ll...
Paracetamol Overdose
Paracetamol overdose is a common presentation in A&E and so you may often find yourself looking after...
Understanding the MSRA
The Multiple Specialty Recruitment Assessment (MSRA) is a computer-based exam increasingly being used...
e-Portfolio
Your e-Portfolio is an online tool to gather and store evidence of progression throughout your time as...
Passing the Prescribing Safety Assessment (PSA)
The PSA is aimed at final year medical students and those graduating overseas to assess their competency...
Common Viral Infections (exanthem) in Paediatrics
Viral infections are extremely common in paediatrics and a common presentation to paediatric A&E...
Thinking about Australia?
Junior Doctors in the UK are increasingly moving to Australia after FY1, for FY3 or other years in between...

Sign up for our awesome resources

Join over 40,000 users who have signed up for our free weekly webinars, referral cheat sheet & other exclusive content!