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BTS guidelines for the insertion of a chest drain
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  • Published on:
    Length of tube in the underwater seal drain as fluid fills in

    Dear Editor,

    Re: BTS guidelines for the insertion of a chest drain.

    This is a wonderful article on chest drain and everything related to it. I do understand that 1-2cm of tube should normally be left underwater when doing an underwater seal drain. My actual site of interest is regarding the length of the tube in the underwater seal when draining a pleural effusion. So when it starts filling in... should we...

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    Conflict of Interest:
    None declared.
  • Published on:
    Chest drain insertion in ventilated patients
    • Murad Ghrew, Consultant in respiratory and critical care medicine

    Dear Editor

    I have read with interest the BTS guidelines for the insertion of a chest drain. In the last paragraph (15) you have recommended that during the insertion of a chest tube in a patient on a high pressure ventilation (especially with positive end expiratory pressure-PEEP), it is essential to disconnect from the ventilator at time of insertion. I have some concerns about this recommendation. I think i...

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    Conflict of Interest:
    None declared.
  • Published on:
    Ventilation and drainage of pleural effusions

    Dear Editor

    The BTS guideline on chest drain management unfortunately fails to recognise the severity of illness of patients who generally require chest drain insertion on an intensive care unit. In our practice chest drainage for pleural effusions only occurs in ventilated patients who require more than 5cm H20 PEEP and still have significantly impaired oxygenation limiting their ability to be weaned fr...

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    Conflict of Interest:
    None declared.
  • Published on:
    Insertion of chest drain guidelines:other experiences
    • Calvin S.H. Ng, Cardiothoracic Surgeon
    • Other Contributors:
      • Professor Anthony P.C. Yim

    Dear Editor

    I read with interest the latest comprehensive BTS guidelines on chest drain insertion. We would like to share with you some tips and words of caution accumulated by experience from our institute.

    During chest drain insertion, we routinely monitor oxygen saturation continuously with or without prior sedation. Patient with secondary pneumothorax i.e. from COAD can deteriorate during chest drai...

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    Conflict of Interest:
    None declared.