Safe insertion of chest tube
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SAFE INSERTION OF CHEST TUBE
Emergency
Remove air or fluid from pleural cavity
By dr sumer yadav
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INDICATIONS
Pneumothorax Empyema Malignant pleural effusion Traumatic hemopneumothorax Postoperative after
esophageal,cardiac ,pulmonary surgery
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CONTRAINDICATIONS Lung adherent to chest wall Uncorrected coagulopathy
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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
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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
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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
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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
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REMOVAL OF CHEST DRAIN
Fully expanded lung No hemo,pneumo No air leak No fresh or altered bld coming Daily drainage <100 cc
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PROC Ask pt to hold breath at end of
inspiration Remove,tighten suture Auscultate and cxr
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