Chest drain insertion (or thoracostomy), is a procedure performed to remove air, fluid, or pus from the pleural space
(the area between the lungs and the chest wall). This procedure is vital in treating conditions like pneumothorax (air
in the pleural space), hemothorax (blood in the pleural space), pleural effusion (excess fluid), or empyema (pus in
the pleural space).
The process begins with patient preparation, which includes explaining the procedure to the patient and ensuring
informed consent. The patient is usually placed in a semi-upright position to allow easier access to the pleural space.
Local anesthesia is administered at the site of insertion to minimize discomfort.
The typical site for chest drain insertion is the 'triangle of safety,' an area bounded by the lateral edge of the
pectoralis major muscle, the lateral edge of the latissimus dorsi, and a horizontal line at the level of the nipple. This
area minimises the risk of damaging vital structures. Using aseptic technique, a small incision is made over the rib to
avoid the neurovascular bundle that runs along the inferior border of each rib. The clinician then creates a passage
through the chest wall into the pleural space, often using a blunt dissection technique. Once the pleural space is
entered, a finger sweep is done to ensure no adhesions or lung tissue are in the way.
A flexible plastic tube (chest drain), is then inserted into the pleural space. The other end of the tube is connected to
a drainage system, which usually includes a water-seal chamber to prevent air from re-entering the pleural space.
The system is kept below the level of the chest to facilitate drainage by gravity. In many cases a negative low suction
pressure system is connected to the drainage system to assist drainage.
After the tube is in place, it's secured to the skin, and a dressing is applied. Chest X-ray is often performed post-
procedure to confirm the correct placement of the tube and the resolution of the initial problem. The patient's
respiratory status and the drainage system are closely monitored thereafter. Removal of the chest drain depends on
the resolution of the underlying condition and the amount of drainage.