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This guidance is for Medical staff and Advanced Neonatal Nurse Practitioners working in Neonatal Intensive Care settings within the MCN for Neonatology, West of Scotland. It relates to the insertion of the Fuhrman Pleural/Pericardial chest drain.
The existence of this guideline does not preclude the use of other chest drain methods which may be preferred for certain circumstances.
The Seldinger method of chest drain insertion has rapidly become the preferred technique for most neonatologists. This is because it is viewed as less “invasive” than the previously used trocar method, and with practice can be inserted quickly and safely. As with any procedure however it carries risks and as such appropriate preparation (including case selection) and technique are vital.
For the Seldinger technique to be safe it is vital that there is a sufficiently large collection of air or fluid in the pleural space for insertion of the needle and so separate needle thoracocentesis prior to drainage should be avoided except in extremis. Small accumulations of pleural air or fluid which the baby is tolerating clinically should be managed conservatively,
Where there is leakage of fluid from a previous drain site (i.e. from pleural effusions /chylothoraces) the Seldinger method should not be used unless an adequate residual fluid collection has been demonstrated. An alternative drain that does not rely on initial needle thoracocentesis should be used.
A chest drain is indicated when there is significant respiratory or circulatory compromise. The decision to proceed to chest drain insertion will generally be made after discussion with the appropriate consultant and following review of current X-rays or other imaging such as thoracic USS. The procedure should be performed by an experienced clinician or under the direct supervision of a consultant, supported, where possible, by a skilled assistant.
In the event that an infant requires a further chest drain because the initial one has been removed or has become dislodged it is not recommended to insert a new drain via the same entry site. This is because an internal tract may have formed which will increase the chance of the wire taking an inappropriate route within the thoracic cavity, eg towards the heart. When multiple drains are required, however, small size may pose difficulties in finding a new entry point for each drain and so clinical judgement must be used in deciding where to place a new drain.
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Last reviewed: 11 February 2019
Next review: 01 February 2022
Author(s): Allan Jackson – Consultant neonatologist PRM
Approved By: WoS Neonatology MCN