Chest tube
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A chest tube or chest drain is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. The procedure is called tube thoracostomy in the U.K.. It is also known as a Bülau drain.
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[edit] Technique
The free end of the tube is usually attached to an underwater seal, below the level of the chest. This allows air or fluid to escape from the pleural space, and prevents anything returning to the chest. Alternatively, the tube can be attached to a flutter valve. This allows patients with pneumothorax to remain more mobile.
Chest tubes are usually inserted under local anesthesia. The skin over the area of insertion is first cleansed with antiseptic solution before sterile drapes are placed around the area. The local anesthetic is injected into the skin and down to the muscle, and after the area is numb a small incision is made in the skin and a passage made through the skin and muscle into the chest. The tube is placed through this passage. If necessary, patients may be given additional painkillers for the procedure. Once the tube is in place it is stitched to the skin to prevent it falling out and a dressing applied to the area. The tube stays in for as long as there is air or fluid to be removed, or risk of air gathering.
Once the drain is in place, a chest radiograph will be taken to check the location of the drain.
Modern types of chest tube are placed using the Seldinger technique, which implies that a blunt guidewire is passed over a trocar, over which the chest tube is then inserted.
[edit] Indications
- Pneumothorax: accumulation of air in the pleural space
- Pleural effusion: accumulation of fluid in the pleural space
- Chylothorax: a collection of lymphatic fluid in the pleural space
- Empyema: a pyogenic infection of the pleural space
- Hemothorax: accumulation of blood in the pleural space
- Hydrothorax: accumulation of serous fluid in the pleural space
[edit] Contraindications
An uncooperative patient, coagulation disorder that can not be corrected are absolute contraindications.
Relative contraindications are site of insertion has known bullous disease, use of positive end-expiratory pressure (PEEP, see mechanical ventilation) and only one functioning lung.
[edit] Complications
Major complications are bleeding (hemorrhage), infection, and reexpansion pulmonary edema.
Minor complications include a subcutaneous hematoma or seroma, anxiety, shortness of breath (dyspnea), and cough (after removing large volume of fluid).
[edit] References
- Intensive Care Medicine by Irwin and Rippe
- The ICU Book by Marino
- Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe
