Chest Tube

Camelia Septina Hutahayan

RS H.L. Manambai Abdulkadir
 Definition

Chest Tube or tube thoracostomy

is the placement of a tube through
the thoracic wall and into the
pleural cavity. It is placed in order
to evacuate air, blood, or other fluid
that collects within the pleural
space.
 Indications
Pneumothorax
Tension
Spontaneous
Iatrogenic
consider while on
mechanical ventilation
Hemothorax
Empyema
Chylothorax
Pleurodesis
Bronchopleural fistulas
Pneumothorax
Fluid in the chest
Contraindications
Coagulopathy
Large pulmonary blebs or bullae
Pulmonary adhesions
Tuberculosis
Previous tube thoracostomies
Mesothelioma is a rare form of cancer that develops from
the protective lining that covers many of the body's internal
organs Its most common site is the pleura
Site Selection:
Pneumothorax: Mid.clav.line
2nd ICS
5th ICS Between Ant. and
Mid Ax. Lines
Pleural Effusion:
5th ICS Post.Axillary Line
EQUIPMENTS
Povidone iodine solution Needle driver
10 to 20 mL syringe Mayo scissors, large curved
Local anesthetic solution (10 to 20 mL Size 0 or 10 suture, silk or nylon
of 1% lidocaine with epinephrine) Petrolatum-impregnated gauze
25 or 27 gauge needle 4x4 gauze squares
#10 surgical scalpel blade on a handle Adhesive tape, 3 to 4 inches wide
Kelly clamps, large and medium Sterile drapes
Chest tubes, sizes 12 to 42 French Sterile gloves
Sterile water Tincture of benzoin spray or swabs
Chest tube drainage apparatus with a 0.25% bupivacaine
water seal
Suction source and tubing
Size of Chest Tube:
Pneumothorax-Small 24
Fr.
Pleural effusion,
hemothorax, empyema
require larger chest
tubes (32 40 fr.)
Procedure: 1. Consent if appropriate
2. Sedation If approprate
3. Prep and Drape Predetermined
spot
Procedure:
1.Local Anesth.
2.Aspirate with needle to
ensure you are in the
desired location.
Procedure:
5. 2-3cm transverse
incision over rib.
BLUNT dissection over top
of lower rib thru subcut.
and muscle with kelly.
6.Puncture Parietal
Peritoneum with Kelly
Pop
Procedure:
7. FINGER SWEEP 360
degrees in pleural space
Procedure:

8. Kelly on chest tube and

insert in.
9. Ensure in far enough
and,look for fogging
Procedure:
10.Connect to underwater
suction,Suture in
,Dressing Chest x-ray
 CHEST TUBE REMOVAL
Remove when:
Original indication for placement is no longer present
Tube becomes nonfunctional.
The following criteria should be met prior to removing
the chest tube:
The lung should be fully expanded
Daily fluid output should be less than 100 to 200 mL/day
An air leak should not exist, either during suction or
coughing
Following inspiration, the patient performs a Valsalva
maneuver and the tube is removed with
simultaneous covering of the insertion site with the
gauze dressing
 Complications:

1. Laceration intrathoracic or abdominal organs

2. Empyema
3. Damage Intercostal neurovascular bundle
4. Poor Tube position,Kinking
5. Subcutaneous Emphysema
6. Re-expansion Pulmonary Edema
(> 1 l fluid off)
TYPES OF CHEST TUBE
DRAINAGE SYSTEM
 Chest Drainage System
1. Fluid Collection Chamber:
Collects fluid as it drains from the pleural space or
mediastinal space
2. Water Seal Chamber:
Acts as a one way valve, allowing air to escape from the
patient and never return back. Always 2 cm of water.
3. Suction Control Chamber:
Controls the amount of suction applied directly to the
patient. It improves the rate and flow of drainage.
THANK YOU