Chest Tubes and Drainage
Insertion
Each method uses sterile technique, and adequate local anesthesia. Position patient for
tube as needed: Axillary line-decubitus position; anterior for pneumothorax-recumbent
position; posterior for blood, pus, or fluid-position patient upright so diaphragm is as
low as possible. Suture tube into place.
- Trocar Tube Thoracostomy: Incision parallel to rib; tube clamped
on insertion.
- Stylet inside trocar cannula; followed by tube placement. Relatively fast, danger
of impaling the lung or another organ. Therefore, carefully control depth of penetration.
- Chest tube with Trocar inside: Same risks as above.
- Operative Tube Thoracostomy: Incision, blunt dissection into
pleura, with digital inspection of space and guidance of tube placement by finger and
large hemostat. Probably safer than trocar method, somewhat more involved.
- Seldinger (guide-wire) Technique: fast, quite safe, least
painful. Difficult to control direction tube goes into pleura. Difficult if adhesions are
expected.
Drainage
- Air Alone-Flutter Valve: atmospheric pressure provides seal of
flutter valve, and allows air to escape from pleura. Generally with a small tube. Simple,
no bulky drainage apparatus.
- Fluid and/or Air: Suction and the three bottle collection
system.
Example: Pleura-evac
- Fluid Collection Chamber
- Water Seal Chamber
- Suction Control Chamber
Chest Tube Care
(3 daily questions and removal)