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Respiratory Skills And Examination
Chest Drain Insertion
- 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)
- Wash hands and apply protective clothing
- Explain to the patient what you are going to do and gain verbal consent
- Infiltrate local anaesthetic into the area of insertion
- The area is prepped and draped appropriately
- An incision is made along the upper border of the rib below the intercostal space to be used.
- The drain track will be directed over the top of the lower rib to avoid the intercostal vessels lying below each rib.
- The incision should easily accommodate the operator's finger.
- Using a curved clamp the track is developed by blunt dissection only. The clamp is inserted into muscle tissue and spread to split the fibres. The track is developed with the operator's finger.
- Once the track comes onto the rib, the clamp is angled just over the rib and dissection continued until the pleural is entered.
- A finger is inserted into the pleural cavity and the area explored for pleural adhesions.
- At this time the lung, diaphragm and heart may be felt, depending on position of the track.
- A large-bore (32 or 36F) chest tube is mounted on the clamp and passed along the track into the pleural cavity.
- The tube is connected to an underwater seal and sutured / secured in place.
- If desired, a U-stitch is placed for subsequent drain removal.
- The chest is re-examined to confirm effect.
- A chest X-ray is taken to confirm placement & position.