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
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
