In summary, following trauma:

Chest drain insertion in the ED is indicated in a patient with a moderate or large pneumothorax, visible haemothorax or hemo/pneumothorax.

Deferred chest drain insertion (in the anaesthetic room) is appropriate if the patient has early surgery planned, is clinically stable and predicted to remain stable.

Contraindications for chest drain insertion

These are rare [4]:

  • Consider checking platelet count and coagulation in those patients with known haematological disorders, or those on warfarin
  • Routine haematological screening of patients is unnecessary