7/31/2019 Chest Tube Trorachostomy

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Alfadz H. Asakil NR-41

Chest tube trorachostomy

A chest tube (chest drain or tube thoracostomy in British medicine or intercostal drain ) is a flexibleplastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood ,chyle) , or pus (empyema) from the intrathoracic space. Itis also known as a Blau draino r an intercostal catheter.

Indication1) Pneumothorax2) Massive pleural effusion3) Emphysema4) Traumatic Haemopneumothorax5) Post operative procedure.

Preparation1) Trolley with dressing pack, chest tube set and suture set.2) 20mL 1% lidocaine3) Scalpel (N15)4) Chest drain (10-14 F, 0r 28-30F for trauma case)5) Underwater drainage bottle6) Connecting tubes7) Suture materials.

Location (Safety triangle)

1) Lateral border of the pectoralis major muscle .

2) Anterior border of the latissimus dorsi.3) Imaginary horizontal level of the nipple Simply put, area of inserton;

4th to 6th intercostals space Anterior to mid axillary line.

Step by step procedure:

Prepare the trolley, drainage bottle and other necessary stuff.Locate the safe triangle

Infiltrate the pleura with 10-20 mL 1% Lidocaine. make sure either air or fluid can be aspired.if not, do not proceed. wait for 3 minutes.

Swab the safe triangle with poviderm Let it dry for a while Put cover to maintain the incision field Make 2cm incision above 6th rib to avoid neurovascular bundle below 5th rib Puncture pleura with scisor or forcep

http://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Hemothoraxhttp://en.wikipedia.org/wiki/Chylehttp://en.wikipedia.org/wiki/Empyemahttp://en.wikipedia.org/wiki/Drain_(surgery)http://en.wikipedia.org/wiki/Drain_(surgery)http://en.wikipedia.org/wiki/Empyemahttp://en.wikipedia.org/wiki/Chylehttp://en.wikipedia.org/wiki/Hemothoraxhttp://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_cavity

7/31/2019 Chest Tube Trorachostomy

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Alfadz H. Asakil NR-41

Sweep finger inside chest to clear adherent lung and exclude stomach in chest. (If use boremore than 24F)

Insert chest tube with guide of trochar. make sure you already clamps the tube first except inpneumothorax only.

Remove the metal trochar and advance the tube until feel resistence.

Attach the drain to the underwater seal via tubing. Then release the clamp. you can see the blood is flowing. Ensure that longer tube is under water and you can see the bubbling with patient's

inspiration. Suture the incision area with mattress or just across the incision site. Fix the drain with second suture tied around the tube like 'Roman gaiter' Remove the clothes. Clean the blood at incisional site. Put gauze on incisional site Secure the drain with tape to prevent it from slipping

Now it, finish. Request CXR to check the position of chest tube. Complications

1) Thoracis or abdominal organ injury2) Damage to long thoracis nerve.

Beware of 1) Retrograde flow into the chest2) Persistent bubbling (may be there's a leak from the lung)3) Blockage of tube due to kink or clot4) Malposition.

Reference: Oxford Handbook of Clinical Medicine 7th edition.