Chest Drain (Seldinger)

Therapeutic

Indications

  1. • Tension / large pneumothorax
  2. • Haemothorax
  3. • Empyema / complicated para-pneumonic effusion
  4. • Malignant effusion

Contraindications

  1. ⚠ Coagulopathy (correct first if non-emergency)
  2. ⚠ Adherent lung
  3. ⚠ Skin infection

Equipment

  1. • Seldinger drain kit 12–14 Fr (effusion) / 16–24 Fr (haemothorax)
  2. • USS for fluid
  3. • Sterile pack, chlorhexidine, drapes
  4. • 1% lidocaine
  5. • Underwater seal drain bottle + tubing
  6. • 0 silk for anchor + drain stitch

Technique

  1. • Triangle of safety: anterior to lat dorsi, lateral to pec major, above 5th ICS, apex at axilla
  2. • USS mark for fluid
  3. • Sterilise, drape, infiltrate lidocaine to pleura
  4. • Insert introducer needle just above rib, aspirate fluid/air
  5. • Pass guidewire, dilate, railroad catheter, advance to ~10 cm
  6. • Connect to underwater seal — confirm swing / bubbling
  7. • Suture anchor + Mersilene drain stitch (closure on removal)
  8. • CXR to confirm position

Complications

  1. ⚠ Bleeding (intercostal artery)
  2. ⚠ Lung / liver / spleen injury
  3. ⚠ Re-expansion pulmonary oedema
  4. ⚠ Drain dislodgement / blockage
  5. ⚠ Surgical emphysema

Aftercare

  1. • Daily review: swing, bubble, drainage volume
  2. • CXR after insertion, when stopped bubbling, before removal
  3. • Remove when air leak resolved + <200 mL/24 h serous

Clinical pearls

  1. • For tension pneumothorax do needle decompression first (5th ICS MAL or 2nd ICS MCL)
  2. • Never clamp a bubbling drain
  3. • Small bore drains adequate for most effusions / pneumothorax

Perform under supervision until competent. Follow local SOPs and consent policy.

WardRound

WardRound

Clinical Decisions in Seconds