Placement of a drain into pleural space to evacuate air, blood, pus or fluid.
Indications
- • Pneumothorax (large/tension after decompression)
- • Hemothorax
- • Empyema
- • Malignant effusion
- • Post-thoracotomy
Contraindications
- ⚠ Coagulopathy (correct)
- ⚠ Adhesions (relative)
Equipment
- • Sterile drape, gown, gloves
- • Antiseptic
- • Local anesthetic (lignocaine 1–2%)
- • Scalpel #11
- • Kelly forceps
- • 24–32 F chest tube (28 F common)
- • Underwater seal drainage
- • Sutures 1-0 silk
- • Occlusive dressing
Positioning
- • Supine or semi-recumbent, arm abducted overhead.
Consent
- • Explain indication, benefits, alternatives
- • Explain risks & complications
- • Obtain written/verbal consent as per SOP
- • Document consent
Universal precautions
- • Hand hygiene
- • PPE — gloves, mask, eye protection
- • Aseptic technique
- • Sharps safety
- • Verify patient identity & site
Step-by-step (0/10)
Tap to complete
Safe triangle — anterior latissimus, lateral pectoralis, 5th ICS at nipple line.
Avoid neurovascular bundle (top of rib)
Immediate complications
- ⚠ Lung/diaphragm/liver/spleen/cardiac injury
- ⚠ Bleeding (intercostal artery)
- ⚠ Malposition
- ⚠ Re-expansion pulmonary edema
Delayed complications
- • Empyema
- • Tube blockage
- • Retained hemothorax
Recognition
- • No swing
- • Continued bleeding
- • Persistent air leak
Initial management
- • Reposition; imaging; surgical review
Prevention
- • Anatomical landmarks
- • Blunt technique
- • Aseptic technique
Post-procedure observation
- • Swing, bubbling, drainage volume
Monitoring
- • Daily CXR
- • Drainage output
Documentation
- • Size, site, depth
- • Initial output
Patient instructions
- • Keep drain below chest
- • Report SOB
Educational bedside guide. Perform only under supervision until competent. Follow local SOPs and consent policy.
