Chest Tube Basics - uscmedicine.blog · Pleural Cavity •Normal: 7-14 ml fluid •Used to balance...
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Chest Tube BasicsBrett Lindgren, DO
Last Updated 8/20/19
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What is a chest tube?
• Tube placed through the chest wall into the pleural cavity to drain air or fluid
https://www.allinahealth.org/mdex/ND0429G.HTM
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Pleural Cavity
• Normal: 7-14 ml fluid• Used to balance system
based on pressure gradient with drainage of fluid• Air or excess fluid is not
normal• 0.15 ml/kg/hr fluid is
produced by parietal pleura
https://en.wikipedia.org/wiki/Pleural_cavity
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Indications for Chest Tube Placement
Air (Gas)
• PneumothoraxFluid (Liquid)• Pleural Effusion
https://en.wikipedia.org/wiki/Pneumothorax https://www.researchgate.net/figure/Chest-X-ray-left-sided-massive-hemothorax_fig4_281514603
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Indications for Tube Placement
Pneumothorax• Spontaneous• Traumatic• Iatrogenic• Tension• Bronchopleural Fistula
Pleural Effusion• Simple (Recurrent)• Parapneumonic• Complicated
• Malignant• Chylothorax• Hemothorax
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Light’s Criteria
• pH• Air in syringe increases pH• Time increases pH• Lidocaine (6.0) decreases pH
ONLY ONE is required to call the effusion an exudate
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Pleural Fluid Tests to Send
Usual Test Sent• Cell count with differential• Protein• LDH• Glucose• pH• Cultures• Cytology
Others
• Flow cytometry, Albumin, Triglycerides/Cholesterol, Amylase• Adenosine Deaminase (ADA)• Hematocrit
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Type of Chest Tubes
• Small Bore (8 -16 Fr) • Large Bore (18 - 40 Fr)
https://www.cookmedical.com/products/cc_utpt_webds/ https://www.americannursetoday.com/managing-chest-tubes-air-leaks-unplanned-tube-removal/
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Pigtail Catheters
• Smaller diameter (Range from 8 – 16 F)• Ideal for evacuating air and fluid• Pneumothorax
• 8-14 Fr
• Parapneumonic Effusion/Malignancy • 10-14 Fr
https://www.cookmedical.com/products/cc_utpt_webds/
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Wayne Pneumothorax Kit
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Chest Tube
https://www.ctsnet.org/article/percutaneous-catheter-spontaneous-pneumothorax
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Drainage Systems
• One- bottle collection system• Two-bottle collection system• Three-bottle collection system
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Three-Bottle Collection System
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Wet Suction
https://www.uptodate.com/contents/image?imageKey=SURG%2F80960~SURG%2F73270&topicKey=SURG%2F7816&source=see_link
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Wet Suction Dry Suction
https://www.getinge.com/int/solutions/acute-care-therapies/thoracic-drainage/wet-or-dry-suction/
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Level of suction
• Typical initial level of suction is -20 cmH20• Pneumothorax• Recommend trial of water seal first
• Fluid Drainage• Trial at -20 cm• If draining large effusion, recommend to minimize large volume suction to
prevent REPE
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What is an Air Leak?
• If presence of air leak• Communication between the
bronchi/alveoli and the pleural space• A Leak in the system outside
the chest
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Chest Tube Removal
• Cause resolved• Air• Leak resolved at least 24 hours on water seal
• Fluid/Blood• Drainage < 100-200 ml/24 hours
• Order of Trial• Suction à Water Seal à Clamping vs Removal
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Clamping Trial
• Pneumothorax• If questions regarding air leak
resolved, a “clamp trial” can be performed• Clamped
• 4-6 hours• Risk of tension pneumothorax• If any respiratory difficulty, unclamp
immediately