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(f )
Figure 17.7 Step-by-step guide: trocar technique. (a) The insertion site
prepped, local anaesthetic infi ltrated and site marked with green needle.
(b) Initial incision. (c) Blunt dissection using forceps. (d) Blunt dissection with
fi nger. (e) Insertion of large drain using introducer. (f) Suturing the drain in
position. (g) The drain secured in position.
Re-expansion pulmonary oedema. Following drainage of a large
effusion or pneumothorax, negative intrathoracic pressure caused
by rapid re-expansion of the lung may cause non-cardiogenic
pulmonary oedema.
document whether the drain is swinging or bubbling, and the
volume of fl uid drained.
Keep the bottle upright and below the level of the insertion site.
A bubbling chest drain should never be clamped.
Management of intercostal drains
When a drain is inserted for a pleural effusion, the drain should
Patients with chest drains should be managed on specialist
be clamped for 1 hour after draining 1 litre of fl uid to reduce the
risk of re-expansion pulmonary oedema.
wards by trained staff. Chest drain charts should be kept which
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