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chest tube; thoracostomy; pleural drainage
Indications:
1) pneumothorax
a) *iatrogenic
b) *spontaneous
c) *tension
d) *traumatic
2) hemothorax
3) chylothorax
4) empyema
5) drainage of recurrent pleural effusion
6) thoracotomy
Contraindications:
1) systemic anticoagulation therapy or bleeding dyscrasia
2) small, stable pneumothorax (may resolve spontaneously)
3) empyema caused by acid-fast organisms
4) loculated hydrothorax or pneumothorax
5) previous chest tube insertion, thoracic surgery or pleurodesis may cause pleura to become stuck together (preventing chest tube insertion)
Complications:
1) injury to heart & great vessels or lung
2) subdiaphragmatic placement of tube
3) open pneumothorax
4) tension pneumothorax
5) dislodgment of tube
6) subcutaneous emphysema
7) unexplained or persistent air leakage
- surgical closure of bronchopleural fistula may be required
8) hemorrhage from an injured intercostal artery
9) local or more generalized infection
Chamber #1: is for fluid collection
Chamber #2: water seal, if no bubbles, no leak
Chamber #3: suction, water level determines suction applied, blubbling indicated specified pressure is applied
A 7-14 French gauge percutaneous catheter may suffice or a lare- bore tube may be required.
Notes:
- review provides nonexpert clinicians
- comprehensive understanding of types of chest tubes
- indications for effective use
- key management details for ideal patient outcomes
General
general surgery
References
- Contributions from Paul Goebel MD, Dept of Medicine, UCSF Fresno
- Anderson D, Chen SA, Godoy LA et al
Comprehensive Review of Chest Tube Management. A Review.
JAMA Surg. 2022;157(3):269-274
PMID: 35080596
https://jamanetwork.com/journals/jamasurgery/fullarticle/2788397