Procedures - Chest drain etc

Question 1

What is the safe triangle for chest tube insertion?

Answer 1

bordered by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, a line superior to the horizontal level of the nipple, and an apex below the axilla

Question 2

Complications of chest drain insertion

Answer 2

• Puncture of any organ – lung, heart, mediastinal structures, bowel, liver, kidney etc
• Misplacement
• Blocked
• Loculated collection with incomplete drainage
• Intercostal artery laceration  haemorrhage  fluid resuscitation and clamping of drain with urgent thoracic surgical consultation

Question 3

Appropriate size of chest drain?

Answer 3

For adults, 28 Fr usually adequate

Intercostal Catheter (guide sizes only):
- Smaller size for draining air
- larger size for draining blood/fluid
Newborn 8-12 FG
Infant   12-16 FG 
Child  16-24 FG 
Adolescent 20-32 FG