Chest drain | North Bristol NHS Trust

What is a chest drain?

A chest drain is a narrow tube that is inserted between the ribs - it sits in the space between the lung and the chest wall. This space is lined on both sides by a membrane called the pleura and is known as the pleural cavity.

A chest drain is inserted when air, fluid, blood, or pus has collected in the pleural space.

What is a chest drain for?

You need a chest drain if you have an air leak (pneumothorax), a collection of fluid (pleural effusion), pus (empyema), or blood (haemothorax) in the pleural space. These can cause problems with breathing and can stop the lungs from working properly. The chest drain allows the fluid or air to leave the body, so your lung to re-expand.

How does a chest drain work?

Once a chest drain has been inserted the external end is connected to a bottle via a tube. The fluid or air travels down the tube, into a bottle, which sits on the ground next to you (or on the charging station if it is an electronic bottle).

Before the chest drain is inserted

Before the chest drain is inserted, the doctor will discuss the procedure, you will be able to ask questions. You will then need to sign a consent form.

Blood tests may be needed before the procedure.

If you are on blood thinning medication, they may need to be stopped before the chest drain is inserted, to minimise the risk of bleeding during the procedure.

Please tell the doctor if and why you take blood thinning medication and they will make a plan with you about when it should be stopped. This can have some rare risks, but is less risky than bleeding during the procedure.

How will the chest drain be put in?

You may be offered painkillers before the procedure starts.
You will sit with your head and arms resting on a pillow on a table, or lie on your bed with your arm above your head.
An ultrasound may be done first, using cool gel on the skin - this will not hurt. Where the chest drain will go will be marked, and once marked, you’ll be asked to keep still.
Your skin is cleaned to reduce infection risk. A local anaesthetic is then injected to numb the area. It may sting briefly, but once it starts to work you should feel only mild pressure during the procedure.
A small cut (approximately 2 to 3mm) is made in the skin and the tube is passed through this into the pleural cavity.
The chest drain is held in place with stitches and the exit site is covered with a waterproof dressing. The end of the tube is connected to a drainage bottle. A chest X-ray will be arranged to check the drain’s position.
Your chest drain will be checked regularly. You will receive regular pain relief while the drain is in place. Pain can limit movement and breathing, and slow lung re‑expansion, so it’s important to report any discomfort so it can be well controlled.

Will the drain be painful?

About half of people with a chest drain have some discomfort, which is usually controlled with simple painkillers. Some may need stronger medication if the pain is more severe. A small number of patients develop coughing or chest discomfort when the lung re‑expands as the air or fluid drains out of the chest. This usually settles quickly. It can be helped by slowing how quickly the pleural fluid drains and using pain relief.

Looking after your chest drain

As the fluid or air around the lung drains you should be able to move more easily. There are a few simple rules that you can follow to minimise any problems:

You can move and walk around with a chest drain but you must remember to carry the drainage bottle with you.
Always carry the bottle below the level of your waist. If it is lifted above your waist level fluid from the bottle may flow back into the pleural space.
Whilst in bed keep the drainage bottle on the floor. If you have a digital bottle make sure it stays in the charging dock when you are not moving about.
Don’t pull on your chest drain or tangle it around your bed.
Do not swing the bottle by the tube.
Try not to knock the bottle over.
If your chest is painful, or you have increasing shortness of breath, please tell your nurse.
If you feel your tube may have moved or may be coming out please tell your nurse.
Inform your nurse if you notice any leaking around the tube or from the bottle.
Inform your nurse if you have a digital bottle and it is alarming or making an unusual noise.

When is the drain taken out?

How long the chest drain will be needed depends on your condition and how well you respond to treatment.

Removing the drain is a simple procedure. Once all the dressings are removed, the stitch is cut and the drain is gently pulled out.

After the chest drain is removed

Once the chest drain has been removed, the site is covered with a gauze dressing. Sometimes a steristrip or a stitch is needed. Steristrips can be removed after 5 days, and you can wash and shower normally after that.

If a stitch is used, it should be removed by your GP practice nurse after 7 to 10 days. Keep the dressing clean and dry until the area is fully healed. Once the dressing and any steristrip or stitch have been removed, you can wash and shower normally If you have discomfort after the drain has been taken out, you can take simple painkillers.

Occasionally after the drain comes out, some fluid can leak out from the wound. If this soaks the dressing, you will need to replace it with the extra gauze and dressing provided.

Are there any risks with chest drains?

In most cases inserting a chest drain is a routine and safe procedure. However, like all medical procedures, there are some possible risks. The most common or serious risks are:

Chest drains sometimes fall out and may need to be replaced (this happens in less than 1 in 10 drains). This risk is reduced by stitching the drain in place and covering it with a secure dressing. You can also help by following the suggestions above (‘Looking after your chest drain’).
Fewer than 1 in 10 drains become blocked, which can stop them working properly. Regular flushes of sterile water may be given to help prevent blockage.
You may feel temporarily dizzy or light-headed when the drain is inserted. This occurs in about 1 in 50 patients and usually goes away quickly.
Chest drains can become infected, but this is uncommon, affecting about 1 in 50 patients. Cleaning the skin and using good aseptic technique helps reduce this risk. If you have a fever or notice increasing pain or redness around the drain site, tell your nurse or doctor.
Bruising around the insertion site is common. Rarely (fewer than 1 in 250 patients), the drain may damage a blood vessel and cause bleeding into the pleural cavity. This often stops on its own, but occasionally an operation or other intervention is needed to control the bleeding.
Occasionally air can collect under the skin near the chest drain, causing swelling or a ‘crackly’ feeling. This is called a subcutaneous emphysema (fewer than 1 in 25 patients). This usually resolves by itself, but occasionally may require a new drain to be inserted or for the drain to be left in longer.
If the lung re‑expands too quickly, fluid can build up in the lung itself (around 1 in 200 patients). This may cause sudden coughing, worsening breathlessness and low oxygen levels. Very rarely, this can be severe and cause respiratory failure. If you notice these symptoms, tell the nursing or medical team as soon as possible. Slowing the rate of drainage may help.
A very rare complication (about 1 in 200 patients) is accidental puncture of another organ. This may involve structures in the chest (such as the lung, heart, diaphragm, or major blood vessels) or abdominal organs (such as the stomach, liver, or spleen). If the lung is punctured, the drain may need to stay in longer. If any organ is injured, additional procedures or an operation may be required.

Further information

If you require further information, please speak to your doctors and nurses.