chest tube insertion

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Chest Tube Insertion Tim Brandys MD FRCSC

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Chest Tube Insertion. Tim Brandys MD FRCSC. Indications:. Pneumothorax(Simple,open,tension). Pneumothorax:. 10% lung volume loss=1 cm Pneumothorax at lateral edge 5 th rib upright CXR 2CM=20% 3CM=30%. Indications:. Evacuate Fluid Hemothorax Effusion(benign,malignant) Empyema. - PowerPoint PPT Presentation

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Page 1: Chest Tube Insertion

Chest Tube Insertion

Tim Brandys MD FRCSC

Page 2: Chest Tube Insertion

Indications:

• Pneumothorax(Simple,open,tension)

Page 3: Chest Tube Insertion

Pneumothorax:

• 10% lung volume loss=1 cm Pneumothorax at lateral edge 5th rib upright CXR

• 2CM=20%• 3CM=30%

Page 4: Chest Tube Insertion

Indications:

Evacuate Fluid• Hemothorax• Effusion(benign,malig

nant)• Empyema

Page 5: Chest Tube Insertion

Indications:

Therapeutic:• Pleurodesis• Intrapleural Chemo.

Page 6: Chest Tube Insertion

Indications:

Suspected lung injury

Patient to go for:• General Anes.• Transport• Positive Press.

Ventilation

Page 7: Chest Tube Insertion

Site Selection:• Pneumothorax:

Mid.clav.line 2nd ICS

5th ICS Between Ant. and Mid Ax. Lines

• Pleural Effusion:

5th ICS Post.Axillary Line Loculated Effusion = Determined Radiologically(U/Sor CT)

Page 8: Chest Tube Insertion

Size of Chest Tube:

• Pneumothorax-Small 24 French

• Hemohorax-Large 38 French

Page 9: Chest Tube Insertion

Procedure:

General Tips:

1. Have everything you need at the bedside.

2.Prep and Drape a wide area.

3.Have a plan B.

Page 10: Chest Tube Insertion

Procedure: 1. Consent if appropriate

2. Sedation If approprate

3. Prep and Drape Predetermined spot

Page 11: Chest Tube Insertion

Procedure:

1.Local Anesth.

2.Aspirate with needle to ensure you are in the desired location.

Page 12: Chest Tube Insertion

Procedure:

5. 2-3cm transverse incision over rib.

BLUNT dissection over top of lower rib thru subcut. and muscle with kelly.

6.Puncture Parietal Peritoneum with Kelly

“Pop”

Page 13: Chest Tube Insertion

Procedure:

7. FINGER SWEEP 360

degrees in pleural space

Page 14: Chest Tube Insertion

Procedure:

8. Kelly on chest tube and insert in.

9. Ensure in far enough and,look for “fogging”

Page 15: Chest Tube Insertion

Procedure:

10.Connect to underwater suction,Suture in ,Dressing Chest x-ray

Page 16: Chest Tube Insertion

Complications:1. Laceration intrathoracic or abdominal

organs(Finger Sweep)

2. Empyema

3. Damage Intercostal neurovascular bundle

4. Poor Tube position,Kinking

5. Subcutaneous Emphysema

6. Re-expansion Pulmonary Edema

(> 1 l fluid off)

Page 17: Chest Tube Insertion

Exam Questions:

• Trauma-How much chest tube drainage mandates urgent Thoracotomy?

• How much fluid has to be present to show up on CXR as a pleural effusion ?

• What are the surface landmarks commonly used to count ICS ?