Chest Drain Insertion in Adult Trauma
Chest drains are critical in managing thoracic trauma by evacuating air or blood from the pleural space, preventing respiratory compromise and tension pneumothorax.
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Indications
- Moderate to Large Pneumothorax
- Drainage indicated if pneumothorax ≥ 2 cm on chest X-ray or any size on CT scan (per BTS guidelines).
- Haemothorax or Haemo/Pneumothorax
- Drainage to remove blood and prevent respiratory compromise.
Contraindications and Considerations
- Check platelet count and coagulation status, especially in patients on anticoagulants.
- In stable patients awaiting surgery, insertion may be deferred to the operating room to reduce infection risk.
- Urgent cardiothoracic consultation is required if any of the following occur post-insertion:
- Immediate drainage of >1500 mL blood or one-third of circulating volume.
- Ongoing blood loss >200 mL/hr for 2-4 hours.
- Continued need for blood transfusion.
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Equipment and Preparation
- Checklist: Use NATSSIP checklist to confirm readiness.