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Chest drains are indicated in hemothorax, symptomatic pleural effusion, large or progressive pneumothorax, and postoperatively in thoracic surgery.
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They can be inserted using either “wide-bore” or Seldinger techniques. More recently, indwelling pleural catheters have been adopted for use in malignant pleural effusions.
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A chest drain can be associated with complications, such as hemothorax, organ perforation, empyema, and postremoval pneumothorax.
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After-care, including analgesia, monitoring, and
Modern Techniques to Insert Chest Drains
Section snippets
Key points
Rehabilitation and recovery
The procedure of inserting a chest drain can be painful. After the procedure, the chest drain pain can continue, and it can be irritating to the visceral pleura and stimulate coughing. The patient should be reassured that this should settle after a short period of time. Analgesia should be given as required.
Ideally, 2 people should carry out drain removal: one to steadily remove the chest drain and the second to cover the skin incision with an adhesive dressing. Drains should be removed at
Clinical results in the literature
Chest drains are inserted frequently in the hospital setting. However, population results are poorly reported in the literature, and studies are limited to small trials. Harris and colleagues3 conducted one of the largest studies of complications following chest drain insertion. A survey was conducted among UK hospitals of complications associated with chest drains from 2003 to 2008. The authors received results from 101 of 148 acute hospital trusts. Over the study period, 20 Seldinger drains
Potential complications/management
Patients who have had chest drains inserted are at risk of several complications. These complications can be divided into early and late complications:
Summary
Chest drains remain a vital and potentially life-saving part of thoracic and respiratory care. There have been several advances in their use, including the development of Seldinger techniques and IPC. They can be associated with significant risks such as hemothorax, organ perforation, and empyema; however, these can be minimized by following a meticulous technique.
References (12)
- et al.
Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists
Chest
(2003) - et al.
Chest tube insertion
N Engl J Med
(2007) - et al.
Survey of major complications of intercostal chest drain insertion in the UK
Postgrad Med J
(2010) - et al.
Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010
Thorax
(2010) - et al.
Seldinger chest drain insertion: simpler but not necessarily safer
Thorax
(2010) - et al.
BTS guidelines for the management of spontaneous pneumothorax
Thorax
(2003)