Large or symptomatic pneumothoraces, or those that occur in mechanically ventilated patients, are easily managed with intercostal chest tube drainage. Seldinger technique or wide-bore chest drains can be used. This article examines the indications for chest drain insertion for pneumothorax and the choice of drain. The equipment required is outlined and the positioning and preparation for the procedure described, including the choice of pre-medication. Techniques for insertion of both Seldinger-style and wide-bore chest drain are also described, including safe administration of local anaesthesia for intercostal block. The procedure outline includes how to place securing sutures and the preferred alternative to the old 'purse-string' technique for later closure of a tract following wide-bore chest drain. Troubleshooting for potential complications is also briefly covered.
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