Practical procedure - Pleural drainage (figure 4a,b,c)

This is best performed in the fifth intercostal space at the anterior axillary line. A 32 French gauge or larger tube should be inserted without the use of a trochar, as this can cause significant damage. After skin incision, blunt dissection is performed and the pleura opened (4a).

After an exploratory finger examination of the pleural cavity (4b) the tube is inserted in a postero-superior direction (4c), fixed to the skin and connected to a one way valve (for example an underwater drain). If no chest drains are available a nasogastric tube may be used with a drainage bag to drain blood (but not air). It is important that the system is closed to prevent air entering the chest via the drainage tube.