Management of medical chest drains (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • Highland HSCP only
  • Secondary care only
  • Adults only

This is not a comprehensive document on how to insert an intrapleural (chest) drain or the indications for inserting a drain.

This guidance is primarily targeted at helping clinicians decide where to look after a patient with a medical chest drain in situ.

The presumption is that most patients should be looked after on the respiratory ward in Raigmore, but there will be situations, particularly related to frailty or patient choice, when a patient with a chest drain in situ may be looked after in a rural general hospital.

This guidance aims to support those clinicians looking after someone with an intrapleural (chest) drain outwith the respiratory ward.

Decision to insert chest drain is made by most senior clinician providing care to patient

  • It is recommended that all non-trauma patients with chest drains, or potential chest drains are discussed with the on-call respiratory consultant
    • Available: Monday to Friday, 0900 to 1700, via Raigmore switchboard.
  • This drain maybe inserted locally if skills permit. Local anaesthetists / surgeons may be able to help.
  • If drain insertion is not required immediately and there is no local expertise then a referral should be made to the on-call respiratory consultant:
    • Available: Monday to Friday 0900 to 1700, via Raigmore switchboard.
    • Outwith these hours: Discuss with on-call Raigmore consultant physician.

Chest drain insertion

  1. Ultrasound is necessary to identify the most suitable location when the reason for insertion is to drain a pleural effusion.
  2. There must be comprehensive documentation regarding the insertion of the drain.
  3. The drain must be sutured in place to minimise the risk of it falling out.
  4. A three way tap must be included in any Seldinger chest drain circuit to facilitate flushing. These three-way taps are included in all Seldinger kits.
  5. The under-water seal system must be correctly set up. Any uncertainty, discuss with ward 7A nursing staff.
    • Available 24/7 on 01463 704379.
  6. A chest x-ray must take place after the insertion to check the position of the drain.

See Royal Marsden chest drain guidance. (Login required).

Management

A decision then needs to be made where the patient with chest drain is best managed. If there is no local expertise, then such patients should be looked after in ward 7A, Raigmore Hospital.

  • Discuss transfer with the on-call respiratory consultant.
    • Available Monday to Friday, 0900 to 1700, via Raigmore switchboard.
  • Outwith these times: discuss with on-call medical consultant.
    • Accessed viaRaigmore switchboard.

In some circumstances it may not be appropriate to transfer a patient to Raigmore, such as when the patient is very frail. Information for providing nursing support can be accessed 24/7 by discussing with the nursing team on ward 7A.

  • Telephone: 01463 704379.

Editorial Information

Last reviewed: 31/10/2024

Next review date: 31/10/2027

Author(s): Respiratory Medicine, Acute Medicine.

Version: 1

Approved By: Approved by TAMSG of the ADTC

Reviewer name(s): Dr E Paterson, Consultant Respiratory Physician, Dr D Scott, Acute Medicine Consultant and Clinical Director, J Latham, Respiratory Nurse Consultant.

Document Id: TAM656