A chest tube insertion is a procedure to place a flexible, hollow drainage tube into the chest in order to remove an abnormal collection of air or fluid from the pleural space (located between the inner and outer lining of the lung).
Chest tube insertions are usually performed as an emergency procedure. Chest tubes are used to treat conditions that can cause the lung to collapse, which occurs because blood or air in the pleural space can hamper the ability of a patient to breath.
There are four common conditions than can require surgical chest tube insertion, including:
There is no available data concerning the demographics of chest tube insertion since this is a common procedure performed in emergency rooms and surgical departments. However, pneumothorax seems to occur most often in males 25–40 years of age.
The point of insertion in the chest most commonly occurs on the side (lateral thorax), at a line drawn from the armpit (anterior axillary line) to the side (lateral) of the nipple in males, or to the side (about 2 in [5 cm]) above the sternoxiphoid junction (lower junction of the sternum, or chest bone) in females. The skin is sterilized with antiseptic solution covering a wide area, and local anesthesia is administered to minimize discomfort. At the rib chosen for insertion, the skin over the rib is anesthetized with lidocaine (a local chemical anesthetic agent) using a 10-cc syringe and 25-gauge needle. At the rib below the rib chosen for pleural insertion, the tissues, muscles, bone, and lining covering the lung are also anesthetized using a 22-gauge needle.
All health-care providers will take precautions to keep the procedure sterile, including the usage of sterile gown, facemask, and eye protection. All equipment must be sterile as well and universal precautions are followed for blood and body fluids. Chest tube size is selected depending on the problem; an 18–20 F(rench) catheter is used for pneumothorax, a 32–26 F catheter for hemothorax, and trauma patients usually require a 38–40 F catheter size; children generally require smaller tube sizes.
The patient's arm is placed over the head with a restraint on the affected side. For an insertion line down the armpit (axillary line insertion), the patient's head is elevated from the bed 30–60°. Using the anesthetic needle and syringe, the physician will insert a needle (aspirate) into the pleural cavity to check for the presence of air or fluid. Then, an incision is made and a clamp is used to open the pleural cavity. At this stage, either air or fluid will rush out when the pleural cavity is opened. The chest tube is positioned for insertion with a clamp and attached to the suction-drain system. A silk suture is used to hold the tube firmly in place. The area is wrapped and an x ray is taken to visualize the status of the tube placement.
The diagnosis for chest tube insertion depends on the primary cause of fluid or air in the pleural cavity. For malignancy (cancer)-causing pleural effusion (fluid in the pleural space filled with malignant cells), the diagnosis can be established with positive cytopathology (cancer cell visualization and analysis) and a chest x ray that shows fluid accumulation.
The typical diagnostic signs and symptoms of empyema (lung infection) include fever, cough, and sputum discharge as well as the development of pleural effusion (causing chest pain and shortness of breath). This type of lung infection can progress to systemic disease with such signs as weakness, and loss of appetite (anorexia). Chest x rays can readily allow the clinician to view the pleural effusion and can also help to detect pneumothorax, since there is visual proof in the displacement of the tissues covering the lungs as a result of air in the pleural cavity. Additionally, during physical examinations, people with pnemothorax have diminished breath sounds, hyperesonance on percussion (a highly resonating sound when the physician taps gently on a patient's back), and diminished ability to expand the chest. Computed axial tomography (CAT) scans can be used to visualize and analyze complicated cases that may require chest tube insertion.
The chest tube typically remains secure and in place until imaging studies such as x rays show that air or fluid has been removed from the pleural cavity. This removal of air or fluid will allow the affected lung to fully re-expand, allowing for adequate or improved breathing. After chest tube insertion, the patient will stay in the hospital until the tube is removed. It is common to expect complete recovery from chest tube insertion and removal. During the stay, the medical and nursing staff will carefully and periodically monitor the chest tube for air leaks or if the patient is having breathing difficulties. Deep breathing and coughing after insertion can help with drainage and lung re-expansion.
Aftercare should also include chest tube removal and follow-up care. The patient is placed in the same position in which the tube was inserted. Using precautions to maintain a sterile field, the suture holding the tube in place is loosened and the chest is prepared for tying the insertion-point wound. The chest tube is then clamped to disconnect the suction system. At this point, the patient will be asked to hold his or her breath, and the clinician will remove the tube with a swift motion. After the suture is tied, dressing (gauze with antibiotic ointment) and tape is securely applied to close the wound. A chest x ray should be repeated soon after tube removal and, within 48 hours, a routine wound care clinic follow-up is advised to remove the dressing and to further assess the patient's medical status and condition.
Although chest tube insertion is a commonly used as a therapeutic measure, there are several complications that can develop, including:
Chest tube insertion is a commonly used procedure, and it is typical for patients to recover fully from insertion and removal. If no complications develop, the procedure can relieve air or fluid accumulation in the pleural cavity that caused breathing impairment. Breathing is usually improved, and follow-up within the immediate 48 hours after hospital discharge is advised so that the patient can be further assessed with x rays and in the wound care clinic.
Mortality and morbidity for chest tube insertion is not strongly associated with the procedure itself. The primary cause responsible for fluid or air accumulation in the pleural cavity is related to continued illness and outcome such as pleural effusions caused by cancer (malignant pleural effusions). Cancer, and not the insertion of a chest tube, determines a patient's sickness and outcome. Chest tube insertion may be problematic in persons affected with certain connective tissue diseases.
The diagnosis, indications, and procedure for chest tube insertion are specific and unambiguous. There is no other alternative to rapidly remove accumulation of fluid or air within the pleural cavity.
Pfenninger, John. Procedures for Primary Care Physicians, 1st Edition. St Louis: Mosby-Year Book, Inc., 1994.
Townsend, Courtney. Sabiston Textbook of Surgery, 16th Edition. St. Louis: W. B. Saunders Company, 2001.
Laith Farid Gulli, MD Nicole Mallory, MS, PA-C Alfredo Mori, MBBS
The procedure is simple and widely utilized. Chest tube insertion is performed in a hospital, usually in the emergency department by an emergency room doctor, resident-in-training, or medical house officer. The medical and nursing team will monitor the patient at the hospital until the tube is removed.
Dr.MS
Thank you
and also why pneumothorax occurs more in tall and thin peoples than others?
please send me its answer soon.
When u have a patient with plenty fluid or gas (450ml ), becareful not to attempt draining it all at once. Also ensure that there's a very reliable and large drip line set for the patient to rush in fluid (into the veins) if the procedure is complicated. At most allow about 200ml of fluid to flow out gradually at once, clamp the draining tube and let out more fluid in about 30min to an hour.
Falure to observe this two precautions may result in a shocked or sometimes dead patient. I had a woman with over 3500ml in the right side of the chest yesterday. Though she was deadly breatless as a result of this, yet we had to balance between the benefits of respiratory relief and dangers of cardivascular collapse. She is happy on the ward now.
Also the doctor already put powder to seal it up,during this should you be on any antiobiotics?
Also havbing the chesttube in place for some days can you get an infeetion from this tube in you with nothing draining out?
Whatever you do do not let your Doctor bully you around for pain medication. No one deserves to live in pain. It has wrecked four years of my life and I am still fighting to find a way to eradicate what I live with everyday. Stay positive.
MUHAMMAD SAJJAD KAYNI SAUDI ARABIA
What is the next step shldbe taken? Any other medications?
2.HOW MANY LONG SHOULD BE CHEST TUBE ?
3.SHOULD THE TUBE CLAMPED WHEN WALKING ARROUND?
I still have pain in my back and rib cage, is this normal and
Is there something I can do to ease the pain
Every now and then I feel like not getting air is this the result after the chest tube, please give me a selution.
Thank you
Can you tell me what it might be and is it something that may go down in time or with surgery ?
We are stil in hospetal becouse of chest tube drain,
The tube which is insert on right side there is air lesk and fluid continue we are wondering what to do now could you plz tell me how we can control this air leak and fluid.
I got right lower lobectomy surgery on Dec. 11, 2014 after surgery stayed in hospital
12 days & removed drained pipes I was discharged
What i feeli g is that some inside in my body which is stucking some
and giving pain as well on the right side.
please advise me what should I do.
thank you
Syed Mujeebullah
I got right lower lobectomy surgery on Dec. 11, 2014 after surgery stayed in hospital
12 days & removed drained pipes I was discharged
What i feeli g is that some inside in my body which is stucking some
and giving pain as well on the right side.
please advise me what should I do.
thank you
Syed Mujeebullah
Thank you
My son age 10 months old . One month back he got heart surgery.we went home after discharge.After 20 days he takes speed breath.we consult a doctor , he suggest us it is emergency go and ask them where operated him.we come back agin and told the doctors who operated the baby about situation. They take him ccu and checked him and insertion a chest tube ,right now we in hospital we are staying from 3 weeks but tube isnot removed, drain is coming day by day it is decreasing sometime increaseing. Please give me sugesstion what is the position of my baby and how many days we need to stay in hospital sir/madam
Is there a time limit for the tube to stay there or does it have to come out even if there is a small quantity of water coming out every week?
Thank you for the info that some one can give me.
My life will never be the same I do physical therapy in home but I do not get better or stronger has anyone have any advice
Tks!