Close Chest Tube Insertion

(Thoracostomy)
What is chest tube insertion?
• A chest tube can help drain air, blood, or fluid from the space
surrounding your lungs, called the pleural space.
• Chest tube insertion is also referred to as chest tube
thoracostomy. It’s typically an emergency procedure. It may also
be done after surgery on organs or tissues in your chest cavity.
• During chest tube insertion, a hollow plastic tube is inserted
between your ribs into the pleural space. The tube may be
connected to a machine to help with the drainage. The tube will
stay in place until the fluid, blood, or air is drained from your
chest.
What it’s used for
You may need a chest tube if you have any of the following:
• a collapsed lung
• a lung infection
• bleeding around your lung, especially after a trauma (such as a
car accident)
• fluid buildup due to another medical condition, such as cancer
or  pneumonia
• breathing difficulty due to a buildup of fluid or air
• surgery, especially lung, heart, or esophageal surgery
• Inserting a chest tube may also help your doctor diagnose other
conditions, such as lung damage or internal injuries after a
trauma.
How to prepare
• Chest tube insertion is most commonly performed
after surgery or as an emergency procedure, so
there’s usually no way for you to prepare for it.
Your doctor will ask for your consent to perform
the procedure if you’re conscious.
• In cases where it isn’t an emergency, your doctor
will order a chest x-ray for chest tube insertion.
This is done to help confirm whether fluid or air
buildup is causing the problem and to determine if
a chest tube is needed. Some other tests may also
be done to evaluate pleural fluid, such as a chest
ultrasound or chest CT scan.
Procedure
Someone who specializes in lung conditions and diseases is called a
pulmonary specialist. A surgeon or pulmonary specialist will usually
perform the chest tube insertion. During chest tube insertion, the
following happens:
• Preparation: Your doctor will prepare a large area on the side of your
chest, from your armpit down to your abdomen and across to your
nipple. Preparation involves sterilizing the area and shaving any hair
from the insertion site, if necessary..
• Anesthesia: The doctor may inject an anesthetic into your skin or vein
to numb the area. The medication will help make you more comfortable
during the chest tube insertion, which can be painful.
• Incision: Using a scalpel, your doctor will make a small (¼- to 1 ½-
inch) incision between your ribs, near the upper part of your chest.
Where they make the incision depends on the reason for the chest tube.
• insertion: Your doctor will then gently open a space into
your chest cavity and guide the tube into your chest. Chest
tubes come in various sizes for different conditions.
Drainage: The tube is then attached to a special one-way
drainage system that allows air or fluid to flow out only.
This prevents the fluid or air from flowing back into the
chest cavity. While the chest tube is in, you’ll probably
need to stay in the hospital.
• How long the chest tube is left in depends on the condition
that caused the buildup of air or fluid. Some lung cancers
can cause fluid to reaccumulate. Doctors may leave the
tubes in for a longer period of time in these cases.
Complications
Chest tube insertion puts you at risk of several complications.
These include:
• Pain during placement: Chest tube insertion is usually very
painful. Your doctor will help manage your pain by injecting
an anesthetic through an IV or directly into the chest tube site.
You’ll be given either general anesthesia, which puts you to
sleep, or local anesthesia, which numbs the area.
• Infection: As with any invasive procedure, there’s a
risk of infection. The use of sterile tools during the
procedure helps reduce this risk.
• Bleeding: A very small amount of bleeding can occur if
a blood vessel is damaged when the chest tube is
inserted.
• Poor tube placement: In some cases, the chest tube can
be placed too far inside or not far enough inside the
pleural space. The tube may also fall out.
Serious complications
• Serious complications are rare, but they can
include:
• bleeding into the pleural space
• injury to the lung, diaphragm, or stomach
• collapsed lung during tube removal