Chest Drain Insertion

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What is a chest drain?

A chest drain is a small tube that is placed through your skin into the space between your lungs and rib cage (the pleural space) to drain fluid or air that should not be there.

Who will be doing the procedure and where?

The procedure will be carried out by a qualified doctor with a suitable level of experience. Because this is a Teaching Hospital, the doctor performing the procedure may be supervised by a senior doctor.

The procedure may take place in a number of locations around the hospital. This may be on a respiratory or general medical ward, in the radiology department, in an acute admissions unit or even in the Emergency Department to avoid any delay (depending on the underlying cause).

How do I prepare for this procedure?

For an emergency procedure

Your doctor looking after you will check if you are on any blood thinning medications and you will also have a blood test before the procedure.

For an elective (non-emergency) procedure

You may be asked to have a blood test a few days before you come to hospital, or on the day of the procedure.

• To minimise risk of bleeding risk associated with the procedure, you may be advised to stop taking some of blood thinning medication. Please only do this when advised by your doctor or from the hospital.
• If you take Clopidogrel, please stop taking it 7 days before the procedure date.
• If you take Warfarin, please stop taking it five days before the procedure date. You will have an INR test on the day of the procedure to ensure it is at a safe level.
• If you take newer anticoagulants Rivaroxaban, Apixaban, Edoxaban or Dagibatran please stop taking or injecting it two days before the procedure date.
• High dose injection like Tinzaparin or Clexane injections will need to be stopped one day before the procedure.
• You do not need to stop taking aspirin before the procedure.

Please contact your doctor or the medical team if you are not sure about stopping your blood thinning medication before the procedure.

You may eat and drink as normal.

What happens during the procedure?

You will be asked to lie down on a bed where the doctor will use an ultrasound machine to see where it is best to insert the drain. The ultrasound lets the doctor ‘look’ through the chest wall to identify the safest site on the skin to carry out the procedure. It is painless and non-invasive. A cool gel is used on the skin first.

Then your skin will be cleaned and a local anaesthetic will be injected to numb the area.

The chest drain will then be inserted between the ribs in the numb area. This is connected to a tube and one-way bag or drainage bottle containing water. The water acts as a one-way seal to allow air or fluid to drain out but not go back in to your chest.

The whole procedure can take up to an hour.

Will it hurt?

The local anaesthetic will sting at first but it will allow the needle to be inserted without causing too much discomfort.

You may feel some pushing and pulling during the procedure. Please tell the doctor if you feel any pain.

How will the drain be attached?

We sometimes use a stitch to tie the drain in and an adhesive dressing on the skin.

Are there any risks during the procedure?

There is a small risk of infection and bleeding but every effort is made to prevent this from happening. There are some other, rarer risks that your doctor will inform you about prior to the procedure.

How long will the drain be in?

It depends on why you need the drain. Your medical team will keep you informed on a regular basis but whilst the drain is in, you will need to stay in hospital, and inform your nurse if you want to leave the ward.

Some people have a little pain after the procedure which may be helped by painkillers. If you have a lot of pain, difficulty breathing or fever, please tell a doctor or nurse so they can look for a cause and treat it.

Important things you need to know about your chest drain

• You may see air bubbling out through the bottle as soon as the drain is inserted; this is normal. This may continue for some time before stopping. If it restarts again, immediately inform your nurse or doctor.
• Fluid will also drain from the chest; this is usually clear but sometimes may be blood stained. This is nothing to be alarmed about.
• There is no need for you to be in pain but if you are in pain ask for painkillers.
• The drain can come out if pulled or twisted so please take care. If the drain does come out tell someone straight away.
• You need to keep the drainage bottle upright, and below the level of the drain (at the point it enters the chest). Usually it is placed on the floor. Take care not to knock it over.
• You may not be able to shower or bathe whilst the drain is in, but the nursing staff can help you with personal care.

How will the drain be removed?

This is straight forward and is usually done by the doctor or a nurse. Once all the dressings are removed, the suture fixing the drain to the skin will be cut and the drain will be gently pulled out. You may be asked to hold your breath in a special way when this is done. It can be uncomfortable but only lasts a few seconds.

A stitch is sometimes used to close the hole, but often only a simple adhesive dressing applied to the skin is all that is needed. This can come off after 24 to 48 hours.

What happens afterwards?

Some people have a little pain after the procedure which may be helped by painkillers. If you have a lot of pain, difficulty breathing, or fever please tell a doctor or nurse so they can look for a cause and treat it.

Who can I contact for more information and support?