BTS guidelines for the insertion of a chest drain
- D Laws1,
- E Neville2,
- J Duffy3,
- on behalf of the British Thoracic Society Pleural Disease Group, a subgroup of the British Thoracic Society Standards of Care Committee
- 1Department of Thoracic Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
- 2Respiratory Centre, St Mary’s Hospital, Portsmouth PO3 6AD, UK
- 3Cardiothoracic Surgery Department, City Hospital, Nottingham NG5 1PB, UK
- Correspondence to:
Dr D Laws, Department of Thoracic Medicine, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK;
diane.laws{at}rbch-tr.swest.nhs.uk
1 BACKGROUND
In current hospital practice chest drains are used in many different clinical settings and doctors in most specialities need to be capable of their safe insertion. The emergency insertion of a large bore chest drain for tension pneumothorax following trauma has been well described by the Advanced Trauma and Life Support (ATLS) recommendations in their instructor’s manual1 and there have been many general descriptions of the step by step method of chest tube insertion.2–9
It has been shown that physicians trained in the method can safely perform tube thoracostomy with 3% early complications and 8% late.10 In these guidelines we discuss the safe insertion of chest tubes in the controlled circumstances usually encountered by physicians. A summary of the process of chest drain insertion is shown in fig 1.
Summary of chest drain insertion process.
2 TRAINING
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All personnel involved with insertion of chest drains should be adequately trained and supervised. [C]
Before insertion of a chest drain, all operators should have been adequately trained and have completed this training appropriately. In all other circumstances, insertion should be supervised by an appropriate trainer. This is part of the SHO core curriculum training process issued by the Royal College of Physicians and trainees should be expected to describe the indications and complications. Trainees should ensure each procedure is documented in their log book and signed by the trainer. With adequate instruction, the risk of complications and patient pain and anxiety can be reduced.11
These guidelines will aid the training of junior doctors in the procedure and should be readily available for consultation by all doctors likely to be required to carry out a chest tube insertion.
3 INDICATIONS
Chest tubes may be useful in many settings, some of which are listed in box 1.
