Follow Us on Instagram
[ Ссылка ]
Chest tube insertions are usually performed as an emergency procedure. Chest tubes are used to treat conditions that can cause the lung to collapse, which occurs because blood or air in the pleural space can hamper the ability of a patient to breath.
There are four common conditions than can require surgical chest tube insertion, including:
pneumothorax (air leak from the lung into the chest)
hemothorax (bleeding into the chest)
empyema (lung abscess or pus in the chest)
pneumothorax or hemothorax after surgery or from trauma to the chest.
SUPPLIES -
Chest tube tray (that includes Kelly clamps x 2 and forceps x 1)
Sterile gloves, gown, hair covering, drapes and towels
Chest tube (size is influenced by the reason for placement)
Adults:
36 - 38 F for large pneumothorax or hemothorax
24 - 32 F for simple/nontraumatic pneumothorax
Pediatrics:
Based on Broselow tape but ranges 12 - 28 F for children and 12 - 18 F for infants
Note: Consider having a back up chest tube available one size smaller to avoid delays
Pleurivac system (or alternative suction device with reservoir) and connection tubing
Betadine or chlorhexidine skin cleansing preparation
Scalpel #10 blade and handle
Nonabsorbable suture (e.g., 1-0 or 2-0 silk)
Xeroform or Vaseline gauze dressing
Sterile 4" x 4" bandages with slits
Elastoplast dressing roll
Adhesive tape
20-guage and 25-gauge needle with 10 ml syringe
Local anesthetic (e.g., 1 - 2% lidocaine with or without epinephrine)
Parenteral analgesia and/or sedative hypnotic.
ANATOMICAL CONSIDERATION -
5th intercostal space at the midaxillary line (note: in most patients this is lateral to the nipple at the point of the midaxillary line)
Considerations & Special Circumstances:
Avoid placement directly over an area of infected soft tissue (e.g., cellulitis or skin abscess)
Avoid going below or through the diaphragm, which can extend up as high as the nipple during full expiration
Consider going into the 4th intercoastal space at the midaxillary line in patients who are pregnant, have ascites from cirrhosis, or large hemoperitoneum where the increased intraabdominal contents and pressure can further elevate the diaphragm.
