Chest tube insertion lab

Tube placement sites

• Depends on purpose–Anterior (triangle of safety)• Pneumothorax

–Low lateral (Ultrasound guidance really helps)• Fluid drainiage

Indications

Triangle of Safety

Incision and Insertion Sites

Dissection OVER rib

Chest tube size

• Air: small• Fluid: medium• Blood: Large• Pus: Large

Alternate procedures

• Simple needle aspiration and recheck–For simple pneumothorax only:• Small• No tension

• Underwater seal jar• Heimlich valve

Tube removal criteria

• Pneumothorax: no bubbling and lung expanded– Consider an interval of tube clamping before removal– Probably best to not remove while on mechanical

ventilation, especially with PEEP• Drainage: less than 200 cc/24 hours• Take care to seal hole during and after removal!• Follow-up chest x-ray

Complications• Bleeding and hemothorax due to intercostal artery perforation• Perforation of visceral organs (lung, heart, diaphragm, or intra-

abdominal organs)• Perforation of major vascular structures such as the aorta or subclavian

vessels • Intercostal neuralgia due to trauma of neurovascular bundles, • Subcutaneous emphysema, • Re-expansion pulmonary edema• Infection of the drainage site• Pneumonia, and empyema• Technical problems such as intermittent tube blockage from clotted

blood, pus, or debris, or incorrect positioning of the tube, which causes ineffective drainage.