Intended for healthcare professionals

Practice Essentials

Managing chest drains on medical wards

BMJ 2018; 363 doi: (Published 21 November 2018) Cite this as: BMJ 2018;363:k4639

This article has a correction. Please see:

  1. F R Millar, ECAT/Wellcome Trust clinical research fellow, specialist registrar in respiratory medicine1 2,
  2. T Hillman, consultant respiratory physician3
  1. 1University of Edinburgh, CRUK Edinburgh Centre, Edinburgh
  2. 2North East Thames deanery, London
  3. 3Department of Thoracic Medicine, University College London Hospital, London.
  1. Correspondence to: Toby Hillman toby.hillman{at}

What you need to know

  • Request a chest x ray immediately after chest drain insertion to check for position and immediate complications

  • When draining a pneumothorax, if there is no swinging or bubbling in the chest drain check whether it is blocked or displaced; when draining a pleural effusion, monitor output and drain no more than 1.5 litres at a time

  • Patients with chest drains require daily review—but the patients are often best placed to tell you if the drain is still working

Managing chest drains on medical wards is a common clinical problem. Pleural disease affects up to 3000 people per million of the population annually in the UK,1 with a substantial number requiring acute pleural intervention in an acute hospital. A national audit in 2010 of 58 acute hospitals in the UK revealed an average of just over seven chest drain insertions per hospital per month. In some settings these procedures are increasingly being performed by respiratory specialists and radiologists as recent British Thoracic Society (BTS) guidelines in the UK necessitate the use of real-time thoracic ultrasonography when inserting a chest drain.2 Thus a scenario often arises where the clinician inserting the drain is not subsequently responsible for the day-to-day management of the patient.

This article aims to summarise common indications for chest drains and the current evidence and guidelines surrounding the use of chest drains. It aims to provide a robust overview for non-specialists of how to manage a chest drain in the acute setting once it has been inserted. We will also briefly discuss the use of chest drains in the outpatient setting, primarily in the form of indwelling pleural catheters.

Sources and selection criteria

Sources of information used to prepare this update include British Thoracic Society clinical guidelines and data from the British Thoracic Society pleural procedures audit. Further data was obtained …

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