CHEST TUBE INSERTION

DEFINITION:

A chest tube is a flexible plastic tube that is inserted through the chest wall and into pleural
space. It is used to remove the air or fluid or pus from the intra thoracic space. It is also known as
Bular drain or an intercostal catheter.

CHARACTERISTICS:

Chest tube are commonly made from clear plastic like PVC and left silicone used and 6 fr to 26
fr for children.

INDICATIONS:

 Pneumothorax- Accumulation of air or gas in the pleural space.

 Pleural effusion- Accumulation of fluids in the pleural space.
 Collapse lung.
 Lung infections.
 Any surgical procedures of lungs and heart.

CONTRAINDICATIONS:

 Presence of any diaphragmatic hernia.

 Any scars in pleural space.

PREPARATION FOR CHEST TUBE INSERTION:

Chest tube is inserted in emergency situations. So there is minimal preparation requirement by

the patient.

 Take consent from parents to perform the procedure.

 X ray should be done.
 Chest ultrasound and CT scan can be performed.

PROCEDURE:

 Prepare a large area on the side of chest clean area with antiseptic like Betadine.
 An intravenous and local anesthesia may be used to make the child comfortable during
the chest tube insertion.
 A small incision is done between the ribs near the upper part of chest.
 A passage is made through the skin and muscle into the chest. The tube is placed through
this passage.
 Once the tube is placed, it is sutured to the skin to prevent it falling out and dressing is
applied to the area.
 Once the drain is in place , a chest radiograph will be taken to check the location of the
drain.
 The tube stays in for as long as there is air or fluid to be removed or risk of air gathering.

CHEST TUBE MANAGEMENT:

 Chest tubes should be kept free of dependent loops, kinks and obsturctions which may
prevent drainage.
 Chest tube drainage should be done to clear the chest tube obstructions.
 The internal lumen may be flushed with the saline.

COMPLICATIONS:

 Haemorrhage
 Infection
 Pulmonary edema
 Possible risk of injury to spleen, liver and diaphragm.
 Subcutaneous haemorrhage.
 Anxiety.
 Shortness of breath.
 Cough.

CHEST TUBE REMOVAL:

The chest tube usually stays for few days. After sure that there is no more fluid or air needs
to be drained, removal of chest tube should be done.

 It is important to removal the chest tube as you are holding yours breathe in or out to
ensure no extra air gets into lungs.
 Afterward a bandage will cover the insertion site.