Skills Checklist: Seldinger Chest Drain Insertion
Skills Checklist: Seldinger Chest Drain Insertion
Completion requirements
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Step 3 · Skills Checklist
Seldinger chest drain insertion (simulation)
Use this checklist on the day. Your faculty member will use the same steps when giving feedback.
Preparation
| Step | Done |
|---|---|
| Confirms the indication, the side and the imaging with the patient and notes | ☐ |
| Checks clotting, anticoagulants, allergies and observations | ☐ |
| Explains the procedure, alternatives and risks; consent recorded | ☐ |
| Completes the LocSSIP sign in with an assistant | ☐ |
| Positions the patient and attaches monitoring | ☐ |
| Checks and lays out the equipment; primes the underwater seal | ☐ |
Ultrasound
| Step | Done |
|---|---|
| Selects the right probe and sets depth and gain | ☐ |
| Identifies ribs, the pleural line, sliding, fluid, the diaphragm and the organs below it | ☐ |
| Watches through the breathing cycle and chooses a safe pocket | ☐ |
| Measures depth to the pleura and the fluid depth; marks the site; patient does not move | ☐ |
Asepsis and anaesthesia
| Step | Done |
|---|---|
| Hand hygiene, gown and sterile gloves; antiseptic allowed to dry; wide drapes | ☐ |
| Time out before the needle | ☐ |
| States the maximum lidocaine dose for this patient | ☐ |
| Infiltrates to the pleura just above the rib, aspirating before each injection; fluid at the expected depth | ☐ |
Seldinger insertion
| Step | Done |
|---|---|
| Introducer needle just above the rib, aspirating; stops as soon as fluid flows | ☐ |
| Passes the guidewire and keeps hold of it at every stage | ☐ |
| Removes the needle over the wire | ☐ |
| Small skin nick; dilates only to the measured depth, without force | ☐ |
| Passes the drain over the wire with all side holes inside the chest | ☐ |
| Removes the wire and stiffener together; closes the tap | ☐ |
| Shows the wire is out and intact | ☐ |
Completion
| Step | Done |
|---|---|
| Connects to the drainage system; checks swinging, bubbling and drainage | ☐ |
| Starts controlled drainage with limits and red flags | ☐ |
| Secures the drain without a purse-string suture; sterile dressing | ☐ |
| Sign out: sharps, chest X-ray request, handover and documentation | ☐ |
Remember
This checklist is for simulation practice. Clinical competence is assessed in your workplace, under your employer's procedures.
Sources
- Asciak R, et al. British Thoracic Society Clinical Statement on pleural procedures. Thorax 2023;78(Suppl 3). doi:10.1136/thorax-2022-219371
- Centre for Perioperative Care. National Safety Standards for Invasive Procedures 2 (NatSSIPs 2), 2023. See NHS England: NatSSIPs
- Association of Respiratory Nurses (ARNS). Good Practice Standards for Controlled Removal of Fluid from Chest Drains (Adults) (2020)
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