In current hospital practice chest drains are used in many different clinical settings and doctors in most specialities need to be capable of their safe insertion.
Indications for chest drain insertion
- in any ventilated patient
- tension pneumothorax after initial needle relief
- persistent or recurrent pneumothorax after simple aspiration
- large secondary spontaneous pneumothorax in patients over 50 years
- Malignant pleural effusion
- Empyema and complicated parapneumonic pleural effusion
- Traumatic haemopneumothorax
- Postoperative—for example, thoracotomy, oesophagectomy, cardiac surgery
Contraindications: There are no absolute contraindications to tube thoracostomy, particularly if the patient is in respiratory distress or has a tension pneumothorax. Anticoagulation or a bleeding diathesis is a relative contraindication in a patient undergoing elective chest tube placement for pleurodesis. Blind insertion of a chest tube is dangerous in a patient with adhesions from infection, previous pleurodesis, or a lung transplant; guidance by CT scan without contrast is preferred in these patients.
- Laws D, Neville E, Duffy J; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the insertion of a chest drain. Thorax. 2003 May;58 Suppl 2:ii53-9. [Medline]
Created May 19, 2009