Chest Tube Insertion

Prepare By :
Amrita :Thapa
Roll No. 7
 CHEST TUBE DRAINAGE

Introduction
A chest tube is a flexible plastic tube that is inserted through
the chest wall and into the pleural space. It is used to remove
air, fluid, blood, or pus from the intrathoracic space. It is also
known as intercostal catheter.
 
 Site for chest tube insertion

• Usually the chest tube is kept through 4th or 5th intercostals

space, on the mid axially line.
• For pneumothorax; in 2nd or 3rd intercostals space along mid
clavicular or interior axcillary line.
• For hemothorax ;6th or 7th intercostal space ,in lateral space in
mid axiallary line
 Purpose
• To permit drainage of air and fluids from the pleural cavity.
• To established normal negative pressure in the plural cavity
for lung expansion.
• To equalize the pressure on both sides of thoracic cavity.
• To provide continuous suction to prevent tension
pneumothorax.
Indications
• Pneumothorax
• Hemothorax
• Chylothorax
• Empyema
• Pleural effusion
• Chest surgeries: Thoracotomy, oesophagectomy , cardiac
surgery etc.

Contraindications
 
• -Coagulopathy
• -Pulmonary bullae
• -Pulmonary, pleural, or thoracic adhesions
• -Skin infection over the chest tube insertion site
• -Lack trained manpower.
Equipment
• Surgical marker
• Lidocain 1% with epinephrine
• Syringes,10-20ml (2)
• Needle,23ga,
• Surgical Blade,
procedure
 Nursing Action

Before procedure
• Verify the physician's order.
• Explain the procedure to the patient.
• Assess patient general condition.eg vital signs
• Assess for pneumothorax , hem thorax and presence of
respiratory distress
• Obtain chest x-ray, CT scan and other supportive
investigations,
• Ensure informed consent.
• Verify right patient and right location.
• Part preparation
 Contd…..

• Assemble all the equipment and drainage system.

• Pre-medicate if indicated
• Tell the patient to expect a needle prick and a sensation of
slight pressure during infiltration anesthesia.
• Assemble necessary equipment and oxygen cylinder at
patient's bedside.
 During procedure
• perform hand hygiene
• Prepare all the article in bed side.
• obtain vital sign and SpO2
• Place the patient in appropriate position.
• Organize in sterile in sterile towel or tray
• Assist the doctor in positioning, cleaning, draping,
anesthetizing the patient's skin, inserting the chest tube and in
attaching drainage system to the chest tube.
• Before inserting the chest tube to pleural space make sure that
the end of the chest tube is clamped ( clamping prevents the
entry of air when the tube enters the pleural space )
• After inserting the chest tube, cover the insertion site with an
occlusive dressing.
 COND
• After securing the chest tube, connect the chest tube
drainage system and seal all the connections with
adhesive tape if required.
• Secure a loop of tubing on patient's gown/body
slightly below the insertion site with insertion site
with adhesive tape.
• Keep the patient comfortably in semi-fowler's
position or high flower's position.
• Perform hand hygiene.A
 After procedure

• Post procedure chest x-ray.

• Keep the patient comfortably in semi-fowler's position or high
fowler’s position.
• Monitor vital sign of respiratory distress, chest pain, breathing
sound.
• Observe the drainage system for blood, air, fluctuation of tube
on respiration.
• Assess for bleeding.
• Monitor the general condition of patient and for sign of
complications.
• Document all relevant information in the chart .
 Complications
• Hemorrhage

• Infection

• Re-expansion pulmonary edema

• Injury to the liver or spleen or diaphragm

(If it is placed inferior to the pleural cavity)
• Injuries to the thoracic aorta and heart
…

• Chest tube clogging caused by thrombus

formation inside the chest tube
• Subcutaneous hematoma
• Subcutaneous emphysema
• chronic pain related to chest tube induced
scarring of the intercostal space
• Dyspnea
• Cough after removing large volume of fluid
THANK YOU