SAFE INSERTION OF CHEST TUBE

Emergency

Remove air or fluid from pleural cavity

By dr sumer yadav

INDICATIONS

Pneumothorax Empyema Malignant pleural effusion Traumatic hemopneumothorax Postoperative after

esophageal,cardiac ,pulmonary surgery

CONTRAINDICATIONS Lung adherent to chest wall Uncorrected coagulopathy

STEPS Check x ray/usg/ct Consent Iv line Aspirate and confirm 5 ICS MAL Safty triangle;ant border of latisimus

dorsi,lat border of pectoralis major,line hz to nipple ,apex towards axilla

Loculated coll use usg guided insertion

POSITION OF PATIENT For pneumo 22 to 24 fr For hemo 28 to 30 fr Supine position most common in

use ,with arm below head In sitting posture leaning over cardiac

trolley required

PROCEDURE Inject local Incision given Track dilated Ask pt to stop breathing during insertion If pt on ventilator,disconnect during

insertion Attach to underwater seal drain Push tube Any tube position can drain air or fluid Apply purse string suture tightly and fix

drain

CARE AFTER INSERTION Encourage to take deep breaths Hold deep inspiration One time drain only 1 ltr To prevent reexpainson pulnonary

edema Keep bottle upright and below chest Auscultate and cxr Milk tube Analgesics

REMOVAL OF CHEST DRAIN

Fully expanded lung No hemo,pneumo No air leak No fresh or altered bld coming Daily drainage <100 cc

PROC Ask pt to hold breath at end of

inspiration Remove,tighten suture Auscultate and cxr