01 Oct

What is a chest tube?

Chest tube is a medical apparatus use to drain liquid or air from the pleural space. It is a common procedure in surgery and emergency department. It is attached to a container (underwater seal).

Indication for inserting chest tube

  1. Pneumothorax (tension or simple)
  2. Haemothorax (massive or simple)
  3. Empyema thoracis
  4. Pleural effusion
  5. After surgery involving thoracic cavity

The first two is common in trauma patients. An injury to the ribs and underlying lung will cause bleeding or an opening to the atmosphere causing air leak into the pleural space. The sub atmospheric pressure in a normal pleural will suck the air. If the hole is small with no possible escape from within, tension pneumothorax occurs.

Location of the chest tube

Chest tube is inserted at the safety triangle. It is a space with minimal tissue and less danger to surrounding structure. The space borders are:

Lateral border of the pectoralis major
Latissimus dorsi
4th/5th ribs

Underwater seal

A container attached to the chest tube with 2 main openings. One opening is attached to the tube from the pleura. This opening is immersed below the water. It acts as a reservoir and creates a negative pressure which force the pleural content to drain. Another opening is a single valve vent that allow air to escape from the container if the pressure is building.

Complications

  1. Bleeding
  2. Ascending infection
  3. Dislodge or blockage
  4. Neuralgia from nerve damage
  5. Intra abdominal injury
  6. Injury to surrounding structure (heart, lung)

Caveat

  • Insert the chest tube above the ribs to prevent any injury to the neuro vascular bundle that traverse below the ribs.
  • Always be cautious not to insert to low to prevent intra abdominal injury
  • Open method is the safest technique of insertion (no usage of trocar, direct insertion of tube into the opened pleura)
  • The bottle must be kept below the patient at all times.
  • Never clamp the tube unless an order from the physician during trial for removal (do not clamp even during transport).
  • Always assess daily to make sure it is function properly or safe for removal.
  • It is not necessary to repeat chest radiograph daily. Once the site is correct, the next radiograph is prior removal or suspected complication.
  • A bronchopleural fistula will cause persistent leak of air (continuous bubbling despite correct location and prolonged tube).
  • Chest tube should not be left more than 2 weeks.

 

 

 

 

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