NW Newborn Clinical Guideline - Pneumothorax

Reviewed by Charge Nurse Newborn

October 2007

This is a delegated medical responsibility that may be undertaken by experienced neonatal nurse.
The chest drain will usually be clamped for 24 hours and an x-ray of chest taken to ensure no reaccumulation of air has occurred.
This is a two person procedure with one sterile and one assisting.

Step	Action
1	Assemble equipment for sterile procedure plus scalpel blade, steristrips, tegaderm, and gauze.
2	Doctor/NS-ANP or nurse puts on sterile gloves.
3	Position baby (chest drain side slightly tilted upwards). Remove tegaderm, sleek plaster and hold drain up slightly.
4	Wound is held together as drain removed
5	The wound should be sealed following removal of the drain. This may be by using steristrips applied to close drain site or by using a small gauze square placed over the thoracotomy incision. Apply tegaderm over the top of the steristrips or the gauze.
6	A routine chest x-ray 4 hours after drain removal is not mandatory. Chest x-rays should be performed if the baby has any significant clinical change following the drain removal.
7	Document removal of drain in: multidisciplinary notes. Level 3 chart.