ASSISSTING FOR CHEST TUBE INSERTION

INTRODUTIO N
Pulmonary air leak is an anticipated risk of mechanical ventilation. Drainage of air or fluid accumulation in
the thorax is an important and necessary skill and is often performed emergently.

When evaluating a suspected pneumothorax, auscultation and transillumination of the chest should be
performed. Note that false positives may result from subcutaneous edema or air. If positive, consider
needle aspiration performed with a 20 or 22 gauge needle connected to a 30 cc syringe via a 3-way
stopcock. After prepping with alcohol, insert needle 3-5 mm into the chest wall in the fourth or fifth
intercostal space in the anterior axillary line. If the infant is supine, air may be easier to access via the
second intercostal space in the mid-clavicular line. 

If pneumothorax is under tension or reaccumulates following needle aspiration, the insertion of a chest
tube (CT) will be necessary. Appropriate insertion sites include the fourth, fifth or sixth intercostal spaces
in the anterior axillary line. The nipple is a landmark for the fourth intercostal space.
PURPOSE
To drain air or fluids that accumulates in the pleural
space. After thoracic surgery.
SCOPE

All the babies with Tension pneumothorax, Pleural Effusion, Haemothorax, Empymachylothorax who
has to undergo ICD.

EUIPMENTS

Sterile gown
Sterile equipment
Sterile gloves
Sterile scissor
Gauze and cotton
(sterile) 1% Xylocaine
10 ml, 5 ml, 2 & 1 ml
syringes Sterile blade
Dynaplast
ICD tube of proper size, (I.C.D catheter, malecot, according to size of the
baby). Sterile water
Water Seal bag
Betadine lotion
Suture materials,
Sterile ICD pack.
PROCEDURE

Sl. STEPS RATIONALE

No.

1 Explain the procedure and reason for the chest tube Explanations decreases anxiety
insertion to parents. and enhance co-operation.

2 Obtain consent. Legal document.

3 Obtain all the diagnostic tests done (chest x ray, arterial Diagnostic testing confirms the
blood gases, coagulation study). presence of air or fluid in the
pleural space, a collapsed lung
and hypoxemia and aids in
prevention of complications.

4 Asses the vital signs. Baseline assessment provides

comparison data for evaluating
changes.

5 Position the baby to the lateral supine (for pneumothorax) If draining air the tube is placed
or semi-fowler position (for hemothorax). near the apex of the lung
(second intercostal space)if
draining fluid the tube is placed
near the base of the lung (fifth
to sixth intercostal space).

6 Open the chest tube tray using sterile technique. Reduces transmission of micro-
organisms.

7 Assist the physician with preparation of the insertion site. Inhibits the growth of bacteria’s
 at the insertion site.

8 Pour antiseptic solution using aseptic technique. For cleansing to maintain

sterility.

9 Wipe the top of the vial of local anesthetic with an alcohol Disinfects the surface of the
swab. vial.

10 Invert the vial so that the anesthetic agent can be To receive content into the
withdrawn into the syringe. syringe.

11 Assist the physician with insertion procedure of the chest By proper positioning and assist
tube. to per formation of the
procedure.

12 Remove the adapter from the end of the connecting tubing Maintains the sterility and
to the collection chamber of the draining system keeping creates a closed system with
the exposed end sterile. Connect to the chest tube. negative pressure.

13 Place the chest draining system below the level of the This position promotes gravity
baby’s chest. drainage and prevents
backflow.

14 Assist with suturing the chest tube in place. Prevents displacement of the
chest tube, the skin next to the
tube is sutured and the ends of
sutures are wrapped around the
tube to the chest wall.

15 Tape all connections points in the chest drainage system Airtight connections keep the