- Complete safety checklist
- Ensure full sterile clothing worn
- Clean the area of drain insertion with chlorhexidine and drape with sterile towels 1
- Palpate the anatomy and identify the optimal site for drain insertion 1
- Infiltrate local anaesthetic to the skin and subcutaneous tissues at the point of insertion 1, taking care to avoid the neurovascular bundle at the inferior border of the rib
- Free air or fluid should be aspirated using your needle at the time of local anaesthetic infiltration – if not stop and seek expert advice for real-time imaging (BTS Guidance)
- Make a 2–3cm incision along the upper edge of the rib that makes the inferior border of the relevant rib space (1)
- Using forceps, bluntly dissect into the pleural cavity (1
- Perform a finger sweep of the pleural cavity 1– enhances blunt dissection, breaking down loculations and acts as a diagnostic examination
- Hold the tip of the drain with the forceps by the distal side hole
- Gently insert the drain into the pleura, aiming either apically or basally as desired with the forceps, and release 1. Disconnect the patient from mechanical ventilation at the point of insertion to reduce the risk of intrapulmonary placement
- Connect to an underwater sealed drainage bottle 1
- If required for sampling attach a 3-way tap to the system for sampling
Securing the Drain
- Suture one end of the incision and place an anchoring suture around the drain
- Pad and stick to the skin using a small transparent dressing. Consider a tape mesentery to prevent kinking
- If used ensure the 3-way tap is accessible