How to contact our teams 

For general enquiries 

• gastroenterologyandhepatologysecretaries@nbt.nhs.uk 
• 0117 414 6499 

For queries related to endoscopy 

• 0117 414 5040 

If you are already a patient known to the gastroenterology or hepatology service, you can email:  

• ibdnurses@nbt.nhs.uk 
• livernurses@nbt.nhs.uk 

How to find us 

We are based in several locations including: 

• Gastroenterology Outpatient Clinic, Level 1, Brunel building Southmead hospital. 
• Specialist Hepatology Clinic (Thursday mornings), Gate 5, Level 1, Brunel building, Southmead hospital  
• Gastroenterology and Hepatology Inpatients, Ward 8a, Level 4, Brunel Building, Southmead
• Hospital 

Find out more about how to find us Our Hospitals | North Bristol NHS Trust  

© North Bristol NHS Trust. This edition published April 2025. Review due April 2028. NBT003606.

Important information

• You should not consume any alcohol on the day or night of the test.
• You should not wear nail varnish or acrylic nails on the night of the test. If you wear nail varnish or acrylic nails the machine will not work.
• The machine must be returned to Respiratory Physiology after two nights. 

Thank you for your cooperation. This will assist us in getting the most accurate information and enable us to provide you with the most appropriate treatment. 

What is overnight oximetry? 

“Overnight oximetry” is a test designed to assess the level of oxygen in your body when you are asleep.

You will need to use this machine for the two nights after you receive it, and then return it to the hospital.

Why do I need to have this test?

This is a simple non-invasive procedure to check that you are taking in enough oxygen when you are asleep. 

What happens during the test?

At the appointment you will collect an overnight oximetry machine, which will be loaned to you by the hospital. This is used overnight in your own home. The Physiologist will explain the test to you and answer any queries you may have. They will show you how to use the machine. The instructions are also attached to the machine. You will be asked to complete some questionnaires to give you further information about your sleep pattern. 

What does the oximetry machine do?

The oximetry machine assesses your blood oxygen levels, your pulse, and your breathing when you are asleep. This is done using a probe attached to the outside of your finger before you go to sleep in bed. 

Frequently asked questions

Will I experience any discomfort or side effects?

When will I be told the results of the test?

What happens if I don’t want to have the test?

Instructions 

What will you receive at your appointment?

What to do part 1

1. Get ready for bed, take all medication as normal. 
2. Place the equipment on your left wrist, as if putting on a wrist watch. 
3. Tighten the band on the equipment so it is comfortable and stable on your wrist. 
4. Just before you get into bed place the grey probe on your ring finger, so the wire is on the back of the hand. Make sure that your finger is not poking out of the end of the probe.

What to do part 2

Once your have completed 2 nights wearing the equipment

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002589

What is a thoracoscopy? 

A thoracoscopy a way of looking inside the space between your lungs and rib cage (the pleural cavity) with a camera.  It is a routine procedure performed with light sedation and local anaesthetic. It is normally done as a day case but some people will need to stay in hospital for a few days afterwards. 

Why do I need a thoracoscopy? 

A thoracoscopy can help diagnose and treat fluid in your chest (pleural effusion). During a thoracoscopy, your doctors will usually:

• take small samples (biopsies) from the inside lining of the chest wall (the pleura)
• remove all of the fluid in your pleural cavity 

In some cases, they may also:

• spray sterile talc powder onto the inside surface of the chest (pleurodesis) to try and prevent fluid from returning
• Insert a semi-permanent catheter into the pleural space (an indwelling pleural catheter or IPC) to allow any further fluid build-up to be drained regularly at home. If an IPC is planned then you should receive a separate leaflet about this.

The procedure takes 30 to 40 minutes.  You will be given local anaesthetic and sedation to make you feel more relaxed but you will be aware of what is going on around you.

What are the benefits of a thoracoscopy?

The biopsies taken during the procedure may help us to understand why the fluid is building up in the pleural cavity. This can also help us work out which treatments will be best for you in the future. The procedure also aims to improve breathlessness by draining the fluid away from the pleural cavity.

Do I have to have the procedure?

It is your decision whether you wish to have the procedure or not. We will fully explain why the procedure has been recommended, and the risks and benefits. You will be given the opportunity to ask any questions.  We will always ask you to sign a consent form. 

What should I do before the procedure?

• Do not to eat anything for at least 6 hours before the procedure. 
• You can take your normal medication in the morning with a sip of water up to 2 hours beforehand. We recommend that you take a simple painkiller like paracetamol on the morning of your procedure.
• It is important you tell us as soon as possible if you are on any blood thinning medication as these may need to be stopped prior to your procedure.
• Please bring with you a list of your normal medications and any allergies to drugs, reading glasses (if needed) and a small overnight bag.

What will happen on the day? 

On the day of your thoracoscopy you will usually be asked to come to Gate 20, Level 2 (medirooms) in the main Brunel Building at Southmead Hospital. 

• During the procedure, you will lie on your side and you will be given some oxygen to breath. You will be given a sedative, pain killing medication and local anaesthetic. A small cut and hole (measuring 1 to 2cm) is made in your chest, and any fluid is drained away. 
• The camera (which is about as wide as a pen), is passed through the hole to look inside the chest. When the biopsy samples are taken, some people can feel a sharp pain inside the chest, but this should only last a second or two each time.
• At the end of the procedure, a flexible tube (chest drain) will be inserted through the hole to allow any remaining fluid or air to drain out. 
• The tube will be stitched in place and attached to a bottle. You may feel the urge to cough after the tube is inserted but this is normal and should pass quickly. 

What will happen after the procedure?

• You will return to your mediroom after the procedure to recover and for monitoring. 
• You will have a chest drain in place, which will drain into a bottle next to you.  The bottle must stay on the floor and below the level of your chest. If you have any concerns about the drain, please let your nurse know.
• 1 to 2 hours after the procedure you will have a chest X-ray and the doctors will decide if the chest drain can be removed.
• If you go home the same day, the chest drain will be removed before you go. You will need to have someone available to stay with you overnight. You will not able to drive for at least 24 hours and until you are comfortable to do so. 
• Some people will need to stay in hospital for a few days after the procedure.
• You can take simple painkillers if needed to manage any discomfort.

Follow up after the procedure 

• You will usually be given an outpatient appointment around 2 weeks after your procedure. 
• If biopsies have been taken, your doctor will discuss the results with you then. Please be aware that biopsies may not always provide a diagnosis.
• Stitches should be removed 7 to 10 days after your procedure. This can either be done by your GP or practice nurse, or we can take it out when you come to your clinic appointment. 

Are there any risks with thoracoscopy? 

Thoracoscopy is a routine and safe procedure. However, like all medical procedures, there are some risks which are important for you to be aware of. The most common and most important risks include: 

Failure of the procedure

In rare cases, it is not possible to remove all the pleural fluid or obtain a biopsy.  This happens in around 1 in 100 cases. 

Pain 

This is common but is rarely severe. Any pain caused by the thoracoscopy is usually controlled with a combination of local anaesthetic, simple painkiller tablets (like paracetamol), and the painkilling injection during the procedure. 

If you are given talc powder into the chest, this can be painful while it is going in or for a few days afterwards. This can also usually be managed with simple painkillers.

A very small number of people may continue to experience pain around the scar (where the camera was inserted) for a few months afterwards. If this occurs, it is usually for very brief moments and can usually be managed with simple painkillers.

Subcutaneous emphysema (air under the skin) 

This occurs in around 1 in 25 patients. It can cause swelling or a ‘crackly’ feeling under the skin, usually just next to the procedure hole. This often settles by itself but very rarely, the swelling can be more extensive and serious. This may mean another drain needs to be inserted. 

Low blood pressure during or after the procedure

This occurs in around 1 in 50 patients and may cause dizziness or light-headedness. This usually settles by itself and does not last long, but may occasionally require treatment. 

Infection of the skin or inside the chest

This occurs in around 1 in 100 patients. It may lead to feeling unwell with fevers and pain, or redness around the drain site. Skin infection can usually be treated with tablet antibiotics at home. Infection inside the chest may require a stay in hospital for intravenous antibiotics and, extremely rarely, an operation.

Persistent air leak 

This occurs in around 1 in 200 patients. During the procedure, if the lung is damaged, a small hole may cause air to leak out into the pleural cavity. If this occurs, the chest drain will need to stay in place until it has healed – this can vary between people.

Tract metastasis 

This occurs in around 1 in 100 patients. If cancer is found inside the chest, this can spread along the path made by the camera during the procedure. Over time this may cause a painful lump to appear around the scar, which may require treatment such as radiotherapy. 

Damage to nearby structures or organs

This occurs in around 1 in 200 patients. During the procedure, organs inside or next to the chest (such as the lung, heart, diaphragm, major blood vessels, stomach, liver or spleen) can be damaged by the camera. If this happens, an additional procedure (such as an operation) may be needed.

Re-expansion pulmonary oedema 

This occurs in around 1 in 200 patients. It is caused by fluid build-up in the lung after it reinflates quickly after the chest drain is inserted and can lead to breathlessness and cough. This usually settles by itself and is short-lived but may occasionally require treatment. 

Bleeding and bruising

A small amount of bruising around the procedure site (or blood staining on dressings) is normal. Very rarely (in less than 1 in 500 patients) significant bleeding at the skin or into the chest can occur. This may require treatment like a blood transfusion or an additional procedure (including surgery) to help control the bleeding. 

Death 

This occurs in much less than 1 in 1000 patients. Any medical procedure carries a very small risk to life, but for thoracoscopy this is extremely low as it is a generally simple and safe procedure.

Your feedback is encouraged 

If you have any questions or feedback for your team, please let them know. We are keen to make thoracoscopy as straightforward and as comfortable as we possibly can. 

We will write down your appointment details for your IPC insertion or removal

• Gate
• On (date)
• At (time) 
• Medication changes

For any queries regarding the procedure, please call the pleural nurses on 0117 414 1027 (Monday to Friday, 8am to 4pm).

Date published: 9 July 2026 Review due: 31 July 2029 PI number: BFT002292

What is a mannitol challenge test?

Mannitol is a naturally occurring sugar. A “mannitol challenge” test is a test that involves inhaling a fine mannitol powder, via an inhaler and assessing the response with a breathing test.

Why do I need to have this test?

The test has been requested to see if you have sensitivity of the airways in your lungs.

What happens during the test?

You will be asked to breathe in different concentrations of mannitol powder, via an inhaler. The concentration of the powder is gradually increased to assess the effect it has on your lungs. After each inhalation you will be asked to perform a simple breathing test, which you have probably done before. 

The whole test will last for approximately one hour.

Will I experience any discomfort or side effects?

Sometimes the test can cause a mild spasm of the airways, which may make you cough or short of breath. This is easily reversed by a common medication (salbutamol) that can be given if required at the end of the test. The powder may make your throat slightly dry which will be relieved with a drink of water.

Important information

It is important that you follow the instructions below carefully. You will not be able to do the test if you don’t.

• Please stop taking all of your inhalers and asthma/ allergy medications (including antihistamines and montelukast) 4 days prior to this test. If required you can take salbutamol (Ventolin) and Bricanyl up to 8 hours prior to the test.
• Please do not smoke for 6 hours prior to your appointment.
• Please avoid foods and drinks that contain caffeine (tea, coffee, chocolate, cola and energy drinks) on the day of your appointment. You can continue to drink all other fluids.
• Please avoid vigorous exercise on the day of your appointment.
• Please inform us if you are pregnant or currently breast-feeding.

If you are unsure about whether you need to stop your medications or have any other questions about this test please contact us using the phone number on the back of this leaflet. 

Thank you for your cooperation. This will help us to obtain accurate information about your lungs and enable us to provide you with the most appropriate treatment.

Reference

Brannan, J.D., Anderson S.D., Perry C.P., Freed-Martens R., Lassig A.R. (2005) The safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic saline. Respir Res. 6:14

© North Bristol NHS Trust. This edition published June 2024. Review due June 2027. NBT002297.

What is a lung function test?

A “lung function test” is a procedure performed to give us accurate information about your breathing and how your lungs work. 

Why do I need to have this test?

This test provides detailed information about your lungs to your clinical team. This will enable them to provide you with the most appropriate plan. 

What happens during the test?

Before the test starts the Physiologist will explain the test to you in detail and will answer any questions you may have.

The lung function test is painless. It involves a series of breathing tests consisting of breathing and blowing through a mouthpiece connected to special equipment.

The test will take approximately half an hour to one hour depending on the information required.

Important instructions

• If you are currently taking any inhalers, please stop taking them four hours before the appointment time.
• Please do not smoke for four hours before the test.
• Please do not drink alcohol for four hours before the test.
• Please do not do any vigorous exercise 30 minutes before the test.
• Please eat and drink as normal.
• Please do not wear lipstick or nail varnish to the appointment.

Thank you for your cooperation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.

Frequently asked questions 

Will I experience any discomfort or side effects?

When will I be told the results of my test?

What should I wear when I attend for my test?

What will happen if I do not want to have this test?

Reference

Cooper, B, Evans, A, Kendrick, A and Newall, C (2005) Practical Handbook of Respiratory Function Testing: Part 1. Association for Respiratory Technology and Physiology.

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002296.

What is an indwelling pleural catheter (IPC)?

An IPC is a soft, flexible tube used to drain fluid from the space between your lungs and rib cage (the pleural cavity). The tube goes under the skin with one end in the fluid and the other outside the chest. It has a one-way valve on it. The pleural fluid can be drained every so often into a bottle or bag. When not in use, it is capped off and covered with a dressing.

Why do I need an IPC?

You have a pleural effusion that is likely to come back. This fluid causes breathlessness. An IPC allows you to drain it regularly, usually at home, to relieve symptoms.

Do I have to have an IPC?

No - this is your choice. Your team will explain the possible benefits, risks and alternatives. This website has more information to help you decide Welcome to ‘My Pleural Effusion Journey’

What should I do before the procedure?

Tell your team if you take blood thinning medications (they may need to be stopped).  We will tell you when to stop and when to restart.

You can eat and drink and take your other medications as usual (unless told otherwise).

Please bring a medication/allergy list and glasses if needed.

What will happen on the day?

On the day of your procedure, you will usually be asked to come to Gate 20, Level 2 (medirooms) in the main Brunel Building at Southmead Hospital. 

• The doctor will meet you before the procedure and you will have a chance to ask them questions. If you are happy to proceed, you will be asked to sign a consent form.
• The procedure is usually done lying on your side. An ultrasound scan will find a safe site to put the drain.  You will receive local anaesthetic. This can sting for a short time before the skin becomes numb.
• Two small cuts are made in your skin (around 1cm each and 5cm apart). You may feel pressure or pulling during the insertion procedure, but it should not be painful. 
• Stitches are placed to hold the tube in place while it heals
• The whole procedure normally takes 15 to 20 minutes and most people go home the same day.

What will happen after the procedure?

• You will be offered painkillers if needed.
• You will have a chest X-ray to check the drain position.
• Most people can go home the same day.  If so, you will need someone to take you home (you shouldn’t drive on the day of the procedure).
• You will usually be given an appointment to speak to a member of the team 2 to 3 weeks after the IPC has been inserted.

Who will drain the fluid at home and how often will this happen?

• Regular IPC drainages are usually done by the district nurses. Your team will make sure they know when to start coming to your house. 
• Once the IPC insertion site has healed, a friend or family member can also be trained to perform drainages if you wish.
• Any stitches will need to be removed after 7 to 10 days. This is usually done by the district nurses.
• Drainages usually start at 3 times per week, but this may be adjusted depending on how much fluid is coming out. 
• Drainages usually last for 5 to 10 minutes. At the end of each drainage you will have a new dressing applied.
• Your district nurses will keep a record of how much fluid is coming out and will inform the hospital team if your fluid dries up.

Looking after your IPC

• The district nurses will also provide you with an information booklet about your IPC.
• In general, you will need to:
  • keep the dressing clean, dry, and intact.
  • keep the area around the IPC dry for the first 4 weeks after insertion
• Between drainages, keep the valve capped and the external tube coiled under the dressing.
• If you develop fever, increasing pain, redness, swelling, leaking, or discharge at the site, let your district nurse or the hospital team know quickly. 
• If you think the IPC is broken or is coming out (or it has come out) then seek urgent help.

Are there any risks with an IPC?

IPC insertion is a routine and safe procedure. However, like all medical procedures, there are some risks which are important for you to be aware of. The most common and most important risks include: 

• Failure to insert the IPC: occasionally it is not possible to insert an IPC because there is not enough pleural fluid. We will use ultrasound to check this before the procedure.
• Pain: after the procedure you may feel bruised or sore for about a week. This usually only needs simple painkillers like paracetamol to control.  Ongoing pain occurs in less than 1 in 100 patients.
• Pain or dragging during drainage: can occur if the lung does not fully re‑expand. Draining slowly and stopping if uncomfortable usually helps.
• Infection of the skin or fluid occurs in less than 1 in 20 people. Good sterile technique and hygiene during drainage reduces the risk. Most skin infections are treated with tablet antibiotics, but infection in the fluid may require intravenous antibiotics and possibly a stay in hospital. Removal of the IPC is rarely needed.
• Dislodgement: this is rare. If you think the catheter has moved out of place, contact your team.
• Bleeding: damage to a blood vessel during insertion causing serious bleeding occurs in less than 1 in 100 people. Rarely, this may need an additional procedure or a blood transfusion.
• Loculations (pockets of fluid) may develop in less than 1 in 7 people. These can limit drainage and increase breathlessness.
• If the IPC has been inserted for fluid due to cancer, tumour growth along the catheter track can occur in around 1 in 20 people (but usually after a few months). Report any new lump or pain around the catheter to the team.
• Blockage from debris in the fluid occurs in less than 1 in 20 people. The team can usually unblock the catheter using simple measures like flushing with water.

How long will the IPC stay in? Will it stop draining?

• The IPC is designed to stay in for as long as needed, as long as it is looked after properly.
• About 1 in 5 (20%) of patients will stop producing fluid naturally within 12 weeks and can have the IPC removed.
• If you have 3 drainages in a row of less than 50ml each, please contact the pleural nurses 
• Some patients may be benefit from having medical talc powder injected into the IPC. Around 2 in 5 (40%) of IPC patients who receive talc will stop producing fluid within 6 weeks. Your doctor will discuss whether talc is the right treatment for you and will arrange this if necessary.

How is the IPC removed?

• The decision to remove an IPC is made with your doctors. 
• IPC removal is usually done as a day case procedure under local anaesthetic. 
• It usually takes 5 to 10 minutes for an IPC to be removed but, in some cases, it may take longer. After the anaesthetic, you will usually only feel pushing and pulling during the procedure. 
• 1 to 3 stitches will be usually be placed after IPC removal. These will need to be removed by the district nurses after 7-10 days.
• There is a small risk of infection and bleeding after a removal. Very rarely, the IPC cannot be fully removed but, if this happens, it doesn’t usually cause long‑term problems. 
• The area may feel sore or bruised for about a week and can be managed with simple painkillers.

Your feedback is encouraged 

If you have any questions or feedback for your team, please let them know. We are keen to make your procedure as straightforward and as comfortable as we possibly can. 

We will write down your appointment details for your IPC insertion or removal

• Gate
• On (date)
• At (time) 
• Medication changes

For any queries regarding the procedure, please call the pleural nurses on 0117 414 1027 (Monday to Friday, 8am to 4pm).

Date published: 9 July 2026 Review due: 31 July 2029 PI number: BFT002498

Important information

• Do not consume any alcohol on the day of the test.
• Wear comfortable clothes; you will need to remove coats and jumpers for this test.
• Take all medication as usual.
• Do not wear nail varnish on the day of the test.

Thank you for your cooperation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.

What is a hyperventilation provocation test?

A hyperventilation provocation test is designed to assess your breathing pattern.

Why do I need to have this test?

This test is used to check that your breathing pattern, and that your body maintains the correct levels of gases in your blood.

What happens during the test?

The Physiologist will explain the test to you and answer any queries that you may have regarding it. You will fill out some questionnaires about symptoms that you may be experiencing. Your breathing will be assessed at rest and you will then be asked to breathe hard and fast for 60 seconds whilst measurements are taken of gases in the air you breathe out.

Frequently asked questions

Will I experience any discomfort or side effects?

You may experience some short-term symptoms during the test. There are no long-term side effects of performing this test

When will I be told the results of my test?

You are usually told your results at your next clinic appointment, or a letter may be sent to your GP or the healthcare professional who referred you for the test.

What will happen if I do not want to have this test?

If you do not have this test we will not be able to pass important diagnostic information to your clinical team. This may affect the medical treatment that you receive.

Reference

Rafferty GF, Saisch SGN, Gardner WN. Relation of hypocapnic symptoms to rate of fall of end-tidal PCO2 in normal subjects. Respir Med 1992;86:335–340.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT002268. 

Important information

Please do not use your inhalers for one week prior to the appointment.

Salbutamol (Ventolin) and Bricanyl can be used up to 8 hours prior to the appointment.

Please stop taking the following medications prior to the test:

• Sodium cromoglycate (8 hours)
• Nedocromil (48 hours)
• Theophyllines (12 to 48 hours)
• Leukotrienes (24 hours)
• Antihistamines (48 hours)

Take all other medication as normal and please bring a list of all medication with you.

• Please do not smoke, consume alcohol, eat a heavy meal or perform heavy exercise within four hours of the test.
• Please do not consume coffee, tea, cola drinks or chocolate on the day of the test.
• Please wear comfortable clothes and shoes suitable for exercise.
• Please do not wear nail varnish or false nails.

Thank you for your co-operation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.

What is an exercise induced asthma test?

An exercise induced asthma test involves some simple breathing tests and exercising on a treadmill to assess whether this causes your airways to become narrower.

Why do I need to have this test?

This test will help us understand if your airways become narrow in response to exercise. This will help us to provide advice on your ongoing treatment.

Who will perform my test?

The test will be performed by two respiratory physiologists. Respiratory physiologists are staff who have extensive training and knowledge in respiratory physiology and performing lung function tests.

What will happen during the test?

Before the test begins the physiologist will explain the test to you in detail and answer any questions that you have.

To begin with you will be asked to perform some breathing tests through a mouthpiece. You will then have ECG stickers attached to your chest to monitor your heart. You will then be asked to exercise on the treadmill for about six minutes. At particular time periods after you have finished exercising you will be asked to repeat the breathing test.

The whole test will last for approximately one hour. 

Frequently asked questions

Will there be any discomfort or side effects of this test?

Sometimes the test can cause a mild spasm of the airways, which may make you cough or feel tight-chested. This is easily reversed by a common medication (Salbutamol) that is given routinely at the end of the test.

Is there a different test I could have?

There is no other basic test that would give us this information about the sensitivity of your airways.

When will I be told the results of my test?

The results will be sent to the professional that requested the test. They will then discuss the results with you at your next appointment.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT002877

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.

© North Bristol NHS Trust. This edition published April 2026. Review due April 2029. NBT003112

Important information

• Please do not wear nail varnish to your appointment.
• Please bring any walking aids (stick etc.) that you regularly use when walking and any oxygen prescribed to you for use whilst walking outside the home.

Thank you for your cooperation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.

What is a 6 minute walk test?

A “6 minute walk” test is a simple procedure performed to give us accurate information about your blood oxygen levels whilst you exercise.

Why do I need to have this test?

This test can be used to determine your exercise capacity and whether you need additional oxygen when you are exercising. In some situations, the 6 minute walk test provides better information of a patient’s ability to perform daily activities.

What happens during the test?

Before the test begins the Physiologist will explain the test to you in detail and will answer any questions that you have.

A probe will be put on your ear. This will provide us with information about your blood oxygen levels. You will then be asked to walk for 6 minutes along a flat corridor.

The test will take approximately half an hour to complete. The length of the test may vary slightly depending on your oxygen levels during the test.

Frequently asked questions

Will I experience any discomfort or side effects?

You may become breathless during the test but there are no long term side effects associated with the test.

Is there a different test I could have?

This is the most basic test that would give us this information about your exercise tolerance and limitations.

When will I be told the results of my test?

You are usually told your results at your next clinic appointment, or a letter may be sent to your GP or the healthcare professional who referred you for the test.

What should I wear when I attend for my test?

You should wear normal comfortable clothing and flat shoes suitable for walking in.

Reference

American Thoracic Society (2002) ATS Statement: Guidelines for the Six-Minute Walk Test American Journal of Respiratory Critical Care Medicine.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT002285