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 1–0 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