Intercostal chest drains (ICDs) are required to remove air or fluid from the pleural space. The insertion of these drains, whilst in the majority of cases a straightforward process, can sometimes be associated with serious complications including patient death1. In 2008 the National Patient Safety Agency issued a Rapid Response Report2 highlighting 12 deaths related to ICD insertion reported via the National Reporting and Learning System between 2005 and 2008. A postal questionnaire sent to physicians at all UK hospitals in 2008 revealed that 67% of responding trusts had encountered a major complication from ICD insertion. Over the period 2003 to 2008, 17 deaths were recalled3. Complications causing patient harm short of death included solid organ injury due to malpositioned drains, trocars or dilators, guidewires lost into the pleural space, intrapleural or drain site infection, drain dislodgement/blockage or pain. Serious complications and deaths reported were as a consequence of both Seldinger and blunt-dissection drain insertion.