chest tube
Chest tube is a procedure that is done to drain fluid,
blood, or air from the space around the lungs. This
procedure may bedone when a patient has a disease,
such as pneumonia or cancer, that causes extra fluid to
build up in the space around the lungs (called a pleural
effusion).
What it’s used for chest tube
You may need a chest tube if you have any of the following:
• a collapsed lung
• a lung infection
• bleeding around your lung, especially after a trauma (such as a car
accident)
• fluid buildup due to another medical condition, such as cancer or
pneumonia
• breathing difficulty due to a buildup of fluid or air
• surgery, especially lung, heart, or esophageal surgery
Inserting a chest tube may also help your doctor diagnose other conditions, such
as lung damage or internal injuries after a trauma.
Equipment required for chest tube insertion
• Sterile gown and gloves
• Sterile drapes
• Suture Set
• Sterile gauze swabs
• Syringes and needles of various sizes
• Local anaesthetic
• Scalpel and blade
• Skin antiseptic i.e. Chlorhexidine in alcohol
• Local anaesthetic – Lignocaine 1% or 2%
• Suture – size 0 – 1
• Instrument for blunt dissection (e.g. curved clamp)
• Connecting tubing
• Closed drainage system (including sterile water for underwater seal)
• A dry non adherent dressing with adhesive border
• Low suction unit for use if required.
Procedure Chest Tube Insertion
1-Preparation: Your doctor will prepare a large area on
the side of your chest, from your armpit down to your
abdomen and across to your nipple. Preparation
involves sterilizing the area and shaving any hair from
the insertion site, if necessary. Your doctor may use an
ultrasound to identify a good location for inserting the
tube.
2-Anesthesia: The doctor may inject an anesthetic into
your skin or vein to numb the area. The medication
will help make you more comfortable during the chest
tube insertion, which can be painful. If you’re having
major heart or lung surgery, you’ll likely be given
general anesthesia and be put to sleep before the
chest tube is inserted.
3-Incision: Using a scalpel, your doctor will make a
small (¼- to 1 ½-inch) incision between your ribs, near
the upper part of your chest. Where they make the
incision depends on the reason for the chest tube.
4-Insertion: Your doctor will then gently open a space
into your chest cavity and guide the tube into your
chest. Chest tubes come in various sizes for different
conditions. Your doctor will stitch the chest tube in
place to prevent it from moving. A sterile bandage will
be applied over the insertion site.
5-Drainage: The tube is then attached to a special one-way drainage
system that allows air or fluid to flow out only. This prevents the fluid or
air from flowing back into the chest cavity. While the chest tube is in,
you’ll probably need to stay in the hospital. A doctor or nurse will
monitor your breathing and check for possible air leaks.
Complications chest tube
• Bleeding in the pleural space
• Injury to the lung, diaphragm, or stomach
• Lung collapse during tube removal
• Bleeding: A very small amount of bleeding can occur if a blood vessel is
damaged when the chest tube is inserted
• Infection: As with any invasive procedure, there is a risk of infection. The
use of sterile instruments during the procedure helps reduce this risk.
• Respiratory failure or inability to breathe
• Pulmonary edema
• Heart attack
Procedure Removing the chest tube
• Perform hand hygiene and don non-sterile gloves, put on face shield.
• Remove dressing and cleanse site with chlorhexidine alcohol solution.
• Remove suture(s) holding chest tube in place.
• Place 4X4’s with Jelonet over chest tube removal site, hold dressing
firmly in place.
• Instruct patient to take a deep breath & hold it (always practice first with
patient when possible) if patient is ventilated cycle with ventilator.
• Retract chest tube ½inch to test for resistance. If resistance is met, stop
procedure and contact physician
References
• Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for
managing spontaneous pneumothoraces. Respir Med. 2009 Oct;103(10):1436-
40.
• Dull KE, Fleisher GR. Pigtail catheters versus large-bore chest tubes for
pneumothoraces in children treated in the emergency department. Pediatr
Emerg Care. 2002 Aug;18(4):265-7.
• Gammie JS et al. The pigtail catheters for pleural drainages: a less invasive
alternative to tube thoracostomy. JSLS. 1999 Jan-Mar;3(1):57–61.
• Hassani B, Foote J, Borgundvaag B. Outpatient management of primary
spontaneous pneumothorax in the emergency department of a community
hospital using a small-bore catheter and a Heimlich valve. Acad Emerg Med.
2009 Jun;16(6):513-8.
• Jones PW, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest.
2003 Feb;123(2):418-23.
