chest tube; thoracostomy; pleural drainage

Indications

• pneumothorax
  • iatrogenic
  • spontaneous
  • tension
  • traumatic
• hemothorax
• chylothorax
• empyema
• drainage of recurrent pleural effusion
• thoracotomy

Contraindications

• systemic anticoagulation therapy or bleeding dyscrasia
• small, stable pneumothorax (may resolve spontaneously)
• empyema caused by acid-fast organisms
• loculated hydrothorax or pneumothorax
• previous chest tube insertion, thoracic surgery or pleurodesis may cause pleura to become stuck together (preventing chest tube insertion)

Complications

• injury to heart & great vessels or lung
• subdiaphragmatic placement of tube
• open pneumothorax
• tension pneumothorax
• dislodgment of tube
• subcutaneous emphysema
• unexplained or persistent air leakage
  • surgical closure of bronchopleural fistula may be required
• hemorrhage from an injured intercostal artery
• local or more generalized infection

Chamber #1: is for fluid collection

Chamber #2: water seal, if no bubbles, no leak

Chamber #3: suction, water level determines suction applied, blubbling indicated specified pressure is applied

A 7-14 French gauge percutaneous catheter may suffice or a lare- bore tube may be required.

Notes

• review provides nonexpert clinicians
  • comprehensive understanding of types of chest tubes
  • indications for effective use
  • key management details for ideal patient outcomes

More general terms

• general surgery