A symptomatic pleural effusion is a common cause of presentation to medical admission units across the UK. Traditionally, large-bore Argyle-type drains were inserted but, over the past decade, there has been a move to inserting small-bore 10–12 French gauge drains using the Seldinger technique.1 In a recently published report, over 20 000 units of one Seldinger-type drain were sold in the UK in 2004.2 The reasons for this include a perceived reduction in patient discomfort and invasiveness, and the apparent ease and speed of insertion of the smaller drains. This change in practice has occurred alongside new methods of training junior doctors, with Modernising Medical Careers and the European Working Time Directive leading to a reduction in their total work hours and a move to shift work patterns. This has inevitably led to reduced trainee experience on the “shop floor”.

Surveys on chest drain insertion have shown that, even among experienced respiratory physicians and thoracic surgeons, overpenetration of the trocar and visceral injuries using Argyle-type chest drains occur.3 4 This led to suggestions to improve safety and the removal of trocars from some Argyle drain packs.

It has been assumed that the recent change in chest drain insertion to the use of smaller bore chest drains inserted using the Seldinger technique is safer, but there is at present no evidence to support this assumption. Unfortunately, they may cause the same array of problems in inexperienced hands and may potentially expose the patient to additional risks from the use of the sharp long dilator in the small-bore catheter packs and, as the blunt dissection technique is not used, the intercostal artery may be more vulnerable using this approach. Complications of small-bore chest tubes …