The Children’s Hospital for Wales runs a regional empyema and complicated pneumonia service for South, West and Mid Wales.

Empyemas are managed using small bore catheter chest drains inserted by radiology colleagues under ultrasound guidance. All chest drains are sited under general anaesthetic.

1. If you receive a referral, please endeavour to get the child transferred to the Children’s Hospital for Wales within office hours.
2. A chest ultrasound should be requested in all children with suspected empyema to assess the size and position of the collection.  Contact the radiology consultant on service during the day, and the on-call radiology SpR out of hours, so that arrangements can be made for the next morning
3. The  respiratory consultant on-call will review and decide whether a chest drain is indicated, and contact the consultant radiologist via the radiology SpR to discuss.  
4. Empyemas can usually be sited during working hours and are usually inserted first thing on the morning CEPOD list. 
5. Once it has been agreed that a drain will be sited, the respiratory team put the child on the CEPOD list and contact the anaesthetist with the history (Category 1B overnight, changing to category 1A at 6am)
6. The overnight specialist SpR changes the CEPOD category to 1A at 6am and will need to attend the 8am CEPOD list meeting in theatre
7. The radiology consultant will consent for the procedure
8. Unless the child is in respiratory distress, minimal fluid needs to be drained in theatre.
9. On arrival on the ward, an underwater chest drain should be set up immediately and the child commenced on a chest drain observation chart (download here).  The nurse should ensure continuous observation for 15 minutes to check there isn’t too rapid drainage of fluid ( see instructions on chest drain  observation chart)
10. Full Guidance on how to manage the chest drain can be found here