Healthcare and Medicine Reference
Therapeutic: Chest Drain
West Midlands Rotation, Birmingham, UK
By the end of this chapter you should be able to:
understand the principles of managing a pneumothorax
understand the indications and contraindications for insertion of
a chest drain
identify and understand the relevant anatomy
be aware of different types of chest drains
describe the procedure of performing a Seldinger and surgical
identify and manage a tension pneumothorax.
Management of pneumothorax
A pneumothorax is defi ned as air in the pleural space (Figure 17.1).
Pneumothorax may be primary, with no existing lung disease, or
secondary to an underlying disease. Examples of secondary pneu-
mothorax include: traumatic (Figure 17.2), iatrogenic or a disease
process such as asthma.
According to current British Thoracic Society (BTS) guidelines,
a primary pneumothorax may not require any treatment if the
patient is not breathless and the pneumothorax is small (rim of
air <2 cm). If treatment is indicated, then the guidelines state that
aspiration should be attempted fi rst, and a second attempt should
be considered if the fi rst is unsuccessful. If aspiration is unsuccess-
ful or repeated aspiration becomes necessary then an intercostal
drain should be inserted. However, in clinical practice, intercostal
drain insertion may be used as the initial treatment in a patient
presenting with a large primary pneumothorax.
A secondary pneumothorax is usually treated initially with
an intercostal drain unless the patient is not breathless, is under
50 years of age and the pneumothorax is small (rim of air <2 cm).
Figure 17.1 A large right-sided pneumothorax.
Indications for intercostal drain insertion
Primary pneumothorax following unsuccessful aspiration.
Tension pneumothorax following needle decompression (see
Figure 17.2 A traumatic pneumothorax.