1. Chest Drain - fundamentals

2. Pleural Aspiration –Tension Pneumothorax
2nd intercostal space midclavicular line
Use venflon or central line catheter (avoid sharp needle’s) O2
Then arrange for chest drain

3. “There is no organ in the thoracic or abdominal cavity that has not been pierced by a chest drain.”

4. Safety Precautions Consent – Written & informed Lignocaine test dose
Check & Ensure the side (right or left) of ICD
Clinical Examination
CXR
O2 must be connected
SpO2 Monitor

5. Position-for Pleural aspiration/ Thoracocentesis ONLY

6. Position - Triangle of safety

7. Chest Drain Insertion Steps

8. Chest Drain Insertion Steps…

10. Underwater Seal Options

11. Post ICD Care Adequate pain control
Ambulate & Chest physiotherapy, O2, Nebulisation……
NEVER Clamp the chest drain – if BPF is persistent –ICD clamping may create tension pneumothorax
Assess for air leak on asking to take deep breath or on coughing –confirm NO air leak
Chest x-ray
ICD column not moving ?
Lung is fully expanded
Blocked (less likely in 28/32 drain)

12. When to Remove ICD NO Air leak (BPF has closed) Lung Fully Expanded
Assess for air leak on asking to take deep breath or on coughing –confirm NO air leak
Lung Fully Expanded
Clinically
Chest x-ray
Drainage is less than 100ml/24hrs