Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [198], C).
2. 2.Show
   Cleanse hands with soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (NHS England and NHSI [179], C).

Procedure

1. 3.Show
   Follow the manufacturer's instructions for opening and filling the bottle with sterile water up to the fluid line.
   To ensure the drainage system is properly set up with enough water to fully immerse the drainage tube and create an underwater seal (Woodrow [290], C).
2. 4.Show
   Undo the taping that secures the chest drain to the chest drain tubing. Do not disconnect at this stage.
   To allow disconnection of the tubing from the chest drain. E
3. 5.Show
   Clamp the chest drain close to the chest wall with two clamps. Clamp the drain for the shortest possible period of time needed to change the tubing and bottle.
   To prevent air entering the chest cavity (Woodrow [290], C).

   Clamping the drain for long periods of time may increase the risk of pneumothorax (Woodrow [290], C).
4. 6.Show
   Remove the old tubing and bottle and clean the chest drain connection. Attach the new tubing to the chest drain.
   To prevent bacterial contamination of the new tubing. E
5. 7.Show
   Immerse the distal end of the tubing into the new chest drain bottle and ensure it is 2–3 cm below the level of the water.
   To create an underwater seal (Havelock et al. [103], C).
6. 8.Show
   Ensure all connections are secure before removing the clamps.
   To prevent accidental disconnection. E
7. 9.Show
   Tape the connection between the chest drain and tubing with an H‐shaped dressing (see Figure 12.30).
   To secure the connection and prevent accidental disconnection. E
8. 10.Show
   Cleanse hands with soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (NICE [193], C).

Post‐procedure

1. 11.Show
   Record the addition of the new bottle on the chest drain observation chart and in the nursing documentation.
   To keep an accurate record of the amount of fluid drained since insertion (Woodrow [290], C).
2. 12.Show
   Observe for any change in the patient's respiratory status and recheck the patient's observations/NEWS. Escalate any concerns or deterioration immediately.
   To identify any concerns or clinical deterioration early and ensure timely escalation to senior staff if required (RCP [230], C; Woodrow [290], C).