Chest Drain Insertion In Children
Emergency
Indications
 Tension Pneumothorax after initial needle thoracocentesis
 Traumatic Haemothorax or Haemopneumothorax
This will be usually be inserted as part of a trauma team in A&E according to
APLS and ATLS guidelines, using a large bore Argyll chest tube as described
in the APLS manual.
This procedure must be carried out by an appropriately trained and
experienced doctor.
This will be a doctor with current APLS or ATLS training.
Equipment
 Skin prep and surgical drapes
 Scalpel
 Large clamps x 2
 Suture
 local anaesthetic
 scissors
 chest drain tube
 underwater seal system
In general, the largest tube which will pass between the ribs should be used
The trocar must not be used to introduce the drain tube due to the high
risk of lung perforation.
Procedure
If haemothorax is suspected large bore IV access and fluid resuscitation
must be commenced prior to drain insertion.
 Identify insertion site :- 5th intercostal space, mid-axillary line
 Swab chest wall with surgical prep
 Give local anaesthetic
 Make 2-3 cm skin incision along the line of the intercostals space, just
above the rib below
 Bluntly dissect through the subcutaneous tissues just over the top of
the rib below, and puncture the parietal pleura with the tip of the clamp.
 Put a gloved finger into the incision to clear a path into the pleura (this
will not be possible in small children)
 Advance the chest drain tube into the pleural space during expiration
 Ensure the tube is in the pleural space by listening for air movement,
and by looking for fogging of the tube during expiration
 Connect the chest drain to the underwater seal
 Suture the drain in place and secure with tape
 Obtain chest X-ray
Purse string suture must not be used due to the risk of unsightly
scarring
Elective
Indications
 Pleural effusion or empyema
Chest drain for any indication other than emergency as above should be
inserted by appropriately trained personnel in a tertiary respiratory centre.
The child must therefore be discussed with and transferred to the paediatric
respiratory team in Leicester (Leicester Royal Infirmary) or Oxford (Oxford
Children’s Hospital, John Radcliffe).
References
Advanced Paediatric Life Support Manual . Fourth Edition 2005
Guidance for the implementation of local Trust policies for the safe insertion of
chest drains in children, following the NPSA Rapid Response Report –
NPSA/2008/RRR003
British Paediatric Respiratory / Society British Thoracic Society 2008