Healthcare and Medicine Reference
In-Depth Information
Box 17.2 Equipment for insertion of a trocar chest drain
Dressing pack and solution (we recommend 2%
chlorhexidine/70% isopropyl alcohol) for cleansing of
the skin
Sterile gloves
Sterile drapes
Gauze
1 or 2% lidocaine
10-mL syringe for local anaesthetic
One blue needle
One green needle
Scalpel
Forceps for blunt dissection e.g. Spencer Wells
Trocar chest drain
Chest drain bottle and tubing
Sterile water for drain bottle
Suture (e.g. size 1 silk)
Figure 17.10 Resolved pneumothorax with a large surgical drain in situ.
Dressing for site of drain insertion
If a pneumothorax fails to resolve after 48 hours, refer to a respi-
ratory physician and consider adding high-volume/low-pressure
suction (e.g. 2.5-5 kPa). You may also consider inserting a bigger
drain. Discuss with the cardiothoracic surgeons if a pneumotho-
rax fails to resolve after 3-5 days.
If a drain stops swinging, it may be blocked, kinked or malposi-
tioned. A blocked drain may be unblocked with a fl ush of 10 mL
of sterile saline. A non-functioning drain should be removed.
Removal of intercostal drains
Following a pneumothorax, the chest drain can be removed when
the drain has stopped bubbling for 24 hours and a CXR confi rms
re-expansion of the lung.
Following a pleural effusion, the chest drain can be removed
when the CXR shows resolution of the effusion. Drain output will
usually be less than 100 mL per day.
To remove a chest drain, fi rstly cut the sutures which are holding
the drain in the skin. Ask the patient to hold their breath in expi-
ration or perform a Valsalva manoeuvre and remove the chest
drain. A suture will be required after removal of larger drains. A
mattress suture may have been previously placed for this purpose.
Apply a dressing and perform a CXR after drain removal.
Figure 17.8 A horizontal mattress suture.
Discharge and follow-up of patients with
pneumothorax
Patients with a pneumothorax who are discharged without active
intervention should be advised to return in 2 weeks' time for a
follow-up CXR.
Patients should be advised to avoid air travel until 6 weeks
following resolution of the pneumothorax.
Scuba diving should be permanently avoided by patients who
have had a pneumothorax unless they undergo bilateral surgical
pleurectomy.
All patients should be given advice to return immediately should
they experience worsening breathlessness.
Figure 17.9 Spencer Wells forceps.
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