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Date issued: August 2022 

For Review: August 2024

Ref: B-457 v2  chest drain final August 2022 v2.pdf [pdf] 292KB

Chest drain Information for patients

Provisional appointment date & time:                ________________________________

Your responsible (lead) consultant is:                ________________________________

Important information about your procedure

• Please tell the doctors and nurses looking after you about any medical conditions you have, and all the medication you take.

• Please tell us if you take any medication to thin the blood: these may need to be stopped before your procedure. You must continue to take any other medication as normal.

• Please seek medical advice if you develop any shortness of breath or increasing chest pain after your procedure.

Please sign and date below to confirm that you have read this information leaflet in full. You will have the opportunity to discuss any questions you might have about the procedure, or any other aspects of your treatment, with a doctor when you come to hospital for your appointment.

Signature:  __________________________________________________

Print name: __________________________________________________

Date: __________________________________________________

What is a chest drain?

A Chest drain is a small tube designed to fit between your ribs into your chest cavity. It is connected to a special bucket that allows the trapped fluid or air within your chest to empty out.

What if I need a chest drain for fluid in my chest?

The pleura is a thin skin that lines both your lung, and the inside of your chest cavity. The space between these two layers of skin is naturally lubricated by a small amount of fluid. In some patients the amount of fluid within the space can accumulate. There are many causes for this. However, if the fluid in your chest is infected or it is fresh blood (usually as the result of trauma), then it will all need to be emptied from your chest. A chest drain enables your doctor to gradually empty this fluid in a controlled manner, until the space is dry.

Sometimes, patients with cancer in the fluid will also have a chest drain inserted to dry the space completely, with a view to subsequent insertion of talc (a sterile talcum powder) to stick the two pleural layers together. This can stop the fluid re-occurring in this select group of patients, with a success rate of between 60 and 80%.

What if I need a chest drain for air in my chest?

Trapped air between the lung and the chest wall is called a pneumothorax. This occurs when there is a small tear in the lung, allowing air to escape out of the lung into the chest cavity. Air can accumulate and squash the lung, making you breathless. Your doctor may recommend a chest drain to allow the air to escape and give time for the tear to heal.

Why do I need a chest drain? Are there alternative tests available?

Your doctor has recommended a chest drain as the best way of controlling any symptoms you might be experiencing. Your doctor will have considered this carefully and made their decision with your best interests in mind. However, it is ultimately your decision as to whether or not you wish to have the procedure done.

Some patients may undergo a pleural aspiration. This is a similar procedure to a chest drain, enabling fluid or air to be drained from the chest cavity, but the drainage tube is removed soon after insertion. Your doctor may try this to manage the fluid/ air initially.

Infected fluid and blood

It is important in the case of infected fluid or blood that all of the fluid is emptied from your chest to get you better. This may not be possible with a pleural aspiration. Infected fluid or blood in the chest can be treated with antibiotics alone, but treatment is most successful when combined with drainage of the fluid.

Chest drains for patients with cancer

Patients with cancer in their fluid can have multiple pleural aspirations, but if your fluid re-accumulates quickly a more permanent solution may be necessary. Options include either a temporary chest drain and subsequent talc insertion (as described above) or a permanent drain that can be managed at home; an IPC. Your doctor will talk you through these two options in more detail to help you make a decision about the best option for you.

Pneumothorax

Air within the chest cavity needs to be drained as long as there remains an open hole in your lung. Without drainage of the air in the chest cavity, the lung and heart can become squashed, which in extreme scenarios can cause death. Once the tear in the lung has healed a chest drain may not be necessary. In some situations your doctor may feel a small device called a PleuralVent may be appropriate to manage your air leak.

If you have any concerns or questions, please let your doctor know and they will be happy to discuss things with you in more detail.

How should I prepare for my chest drain?

• Please let us know in advance if you are:

  • Pregnant

  • Taking medication to thin your blood

If any of these apply to you, we will need to make special arrangements for your procedure. These may include instructions as to what you should do with your medication.

• Please bring the following items with you on the day of your procedure:

  • reading glasses, if you need them

What should I do with my medications?

It is important to let us know in advance if you are taking medication to thin the blood. These will need to be stopped temporarily before your procedure can go ahead. Your procedure may need to be cancelled if you do not follow these instructions.

Please take your other medication as normal

The table below explains what you should do with your medication in more detail. Please contact your doctor if you are not sure what to do. If your blood thinning medication cannot be stopped then your doctor may change it to an alternative medication temporarily, to enable the procedure to take place. The doctors on the ward will ensure the correct changes are made on your inpatient drug chart.

Blood thinning medications

Medication                               Instructions

Warfarin                                     Stop 7 full days before your procedure. You will need to have an INR blood test with your GP or at the hospital 1-2 days before                                                         your procedure to make sure your INR is less than 1.5; otherwise we may need to cancel your procedure.  

Aspirin                                       Stop 1 full day before your procedure.

 

 Clopidogrel (Plavix)

Dipyridamole (Persantin)           Stop 7 full days before your procedure.

Ticagrelor (Brilique)

 

Apixaban (Eliquis)

Dabigatran (Pradaxa)

Edoxaban (Savaysa)              Stop 2 full days before your procedure.

Rivaroxaban (Xarelto)

 

Dalteparin (Fragmin)

Enoxaparin (Clexane)         Stop 1 full day before your procedure.

Tinzaparin (Innohep)

What will happen on the day of my procedure?

You will be contacted by the team to inform you of the precise time and location of your procedure in advance. You will be greeted by a member of the team who will check your observations (e.g., heart rate, blood pressure, temperature) and go through a checklist with you. This will include questions about your medical history, medications, and allergies.

A member of the team may take some blood tests if these have not been checked in advance. The procedure will be explained to you in more detail, and you will be asked to sign a consent form to confirm you are happy to go ahead.

A doctor may do an ultrasound scan of your chest to help decide where to insert the drain safely (this will occur if you have fluid in the space but may not be necessary if we are draining air). An ultrasound scan involves placing gel and a hand-held probe over your skin to create a picture on a screen. The ultrasound scan should not be painful. The doctor will then inject local anaesthetic into your chest wall – this may sting at first, but will soon numb the area so you do not feel anything during the procedure.

Once the area is numb, the doctor will be able to insert the drain into the fluid/air. You may feel a pushing sensation as the drain is inserted but it shouldn’t feel sharp or painful. Once the drain is correctly sited it will be held in position with a stitch and a dressing. The drain is attached to a specially designed bucket with some water in the bottom. This bucket will need to be carried with you when you walk around. It should be carried low (like a suitcase), not up high (like a handbag) or there is a risk the fluid will drain back into the chest cavity.

The chest drain insertion usually lasts between 20 and 40 minutes.

What are the risks of the procedure?

Chest drain insertion is generally a very safe procedure, and serious complications are rare.

• Pain

You will experience pain in association with the procedure, but this is rarely severe. There is likely to be discomfort associated with the local anaesthetic and after the procedure the site may feel bruised. It is normal for your chest to be sore whilst the drain is in your chest and for a week or so after your procedure; this can be managed with painkillers. Some patients will feel their chest is tight and they may have a cough for a few days following the procedure, if a larger volume of fluid is drained. Your doctor will control the amount of fluid that is drained from your chest to minimise this side effect.

• Infection

There is a low but important risk of introducing an infection following a chest drain insertion. This can usually be treated with antibiotics. Very rarely, infections can be more serious and need surgical treatment (an operation). Your doctor will take precautions during the procedure to ensure that this risk is minimised.

• Bleeding

A small amount of bleeding at the site of the procedure is normal. However, a small amount of people have significant bleeding during their procedure. This can usually be managed at the time of the procedure, but very rarely surgical treatment (an operation) is required.

• Injury to underlying organs

Your doctor will use an ultrasound scanner to locate the fluid for the procedure to minimise risk of damage to organs. In the case of air in the cavity there is a recommended safe site for insertion. However, there is a risk that the needles used to insert the drain can damage the lung, liver, spleen or heart. This may require a longer hospital stay or a surgical procedure. Very rarely patients have died from chest drain insertion. Your doctor will take every precaution to minimise the risk of any damage.

What happens after the procedure?

After the procedure a member of the team will take you back to your ward where you will have your observations (blood pressure, oxygen levels, heart rate and temperature) checked again. The team will also arrange for you to have a chest x-ray. If you are in any discomfort, we will give you painkillers to manage this. You must let your nurse and/or doctor know if your chest becomes increasingly painful or you feel increasingly short of breath.

How long does my chest drain have to stay in?

The length of time your chest drain needs to remain in for varies amongst all our patients. Some patients will only need a drain for 24 hours, however, in cases of infection or on-going air leak your drain may need to stay in for several weeks. Your doctor will keep you updated throughout your hospital stay.

Pleural Secretary:

Tel: (01752) 431496

Respiratory Fast Track Coordinators

Tel: 01752 763863

In the event of an emergency, please contact your on-call GP or NHS 111 for further advice