Chest Tube

Chest Tube
• When consulted for a chest tube, you should inform the attending
whether you inserted a chest tube alone before or NOT
• DO NOT make a hero , it is a patient’s life.
Before inserting a chest tube?
Before inserting a chest tube
1. Indication of chest tube ?
2. Presence of a CT SCAN ?? Or only CXRs
3. Official Reports present
4. Inform the attending
5. Fully fill the consult paper
What are the indications of the chest
tube ?
Indications of a chest tube placement
• Pneumothorax: moderate or severe only
• Hemo-thorax (but if drained more than 1000 cc  indication for
thoracotomy)
• Recurrent pleural effusion
• Severe symptomatic pleural effusion
• Para pneumonic effusion
• Empyema
• Following cardiac or thoracic surgeries
What do you need to insert a chest tube??
• Chest tube 28 or 32 (use 28 except for empyema use CT 32)
• Chest bottle or pleurovac (more expensive try not to use it)
• Blade 11
• Dressing set, make sure to have a large Kelly, if not, ask them to get one.
• Surgilon 1
• Betadine
• Gauze
• Lidocaine
• Needle 25 and 18
• Sterile gloves
• Sterile gown
• I-sheet
What is a pleurovac ??
• A Pleurovac
is a drainage system used to eliminate gas or liquid content formed in
the
pleura
• The system collects drainage from a chest tube
• A Pleur-evac
is a single-use drainage system used for continuous suction of the ple
ural space, for either pleural effusion or spontaneous
pneumothorax
• It
uses a water column to regulate the suction, as well as an in-line regul
ator, both set to 20 mmHg
Steps to insert a chest tube
Step 1
• Search for the safe triangle
• count till you reach the space between the 4th and 5th intercostal
space
• Move to the mid-axillary line
• Slightly anterior to it, mark it up.
Steps to insert a chest tube
Steps to insert a chest tube
Step 2
• Prepare all the instruments in
sterile matter and stuff you need
and take lidocaine about 10-20
cc (in a sterile matter)
• Place the patient’s arm over
their head, with the help of the
nurse
• Start scrubbing and place the
sterile drape.
Step 3
• Inject local anesthesia, start with
the needle 25 or 27 over the skin
• Take a needle 18 and start giving
local more deep with aspiration
before each injection until
reaching the rib
• Over pass the rib and aspirate 
if fluid aspirated then in the righ
place.
NEVER insert a Chest tube if no fluid were
encountered upon aspiration by a NEEDLE
Steps to insert a chest tube
Step 4 Step 5
• Incision • Separation of the layers till
reaching the rib with the Kelly
• Moving directly above the rib
and not below it
• Opening of the pleura with the
Kelly
Steps to insert a chest tube
Step 6 Step 7
• Insertion of the chest tube • Put 400 cc in the chest bottle
through the same whole done and then insert the chest tube to
with the kelly. the chest bottle
• When trocar bypass the ribs
directly remove trocar slowly
and insert the rest of the chest
tube slowly at the same time
• Directly clamp the chest tube
with a kelly and a gauze
Steps to insert a chest tube
Step 7 Step 8
• Suture around the chest tube • Apply dressing
What to check on daily basis ?
1. Amount
2. Color
3. Oscillating?
4. Dressing
5. Site of insertion
6. Suction and if is working?
When to remove a chest tube?
Pleural effusion and hemothorax
• Full expansion of lung on CXR
• Improved respiratory status
• Drained less than 50 cc in 24 hrs
Pneumothorax
• At least left for 24hrs
• No air leak present even with
cough
• Full expansion of lung on CXR
How to remove a chest tube ??