Chest tube insertion

Answer 1

Definition

A chest tube insertion involves the surgical placement of a hollow, flexible drainage tube into the chest.

Alternative Names

Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy

Description

Chest tubes are inserted to drain blood, fluid, or air and to allow the lungs to fully expand. The tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space).

The area where the tube will be inserted is numbed (local anesthesia). Sometimes sedation (medication to make you relaxed and sleepy) is also used. The chest tube is inserted through an incision between the ribs into the chest and is connected to a bottle or canister that contains sterile water. Suction is attached to the system for drainage. A stitch (suture) and adhesive tape keep the tube in place.

The chest tube usually stays in place until x-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed. Most people don't need medications to sedate or numb them while the chest tube is removed. Antibiotics may be used to prevent or treat infection.

In certain people, the chest tube may be inserted using a minimally invasive technique guided by x-ray. Sometimes chest tubes are placed during major lung or heart surgery while the person is under general anesthesia.

Why the Procedure Is Performed

Chest tubes are used to treat conditions that can cause the lung to collapse, such as:

• After surgery or trauma in the chest (pneumothorax or hemothorax)
• Air leaks from the lung into the chest (pneumothorax)
• Bleeding into the chest (hemothorax)
• Lung abscessesor pus in the chest (empyema)

Risks

Risks for any anesthesia are:

• Problems breathing
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Infection

After the Procedure

Most people completely recover from the chest tube insertion and removal. There is only a small scar.

Outlook (Prognosis)

You will stay in the hospital until the chest tube is removed. While the chest tube is in place, the nursing staff will carefully check for possible air leaks, breathing difficulties, and the need for additional oxygen. You'll need to breathe deeply and cough often to help re-expand the lung, assist with drainage, and prevent fluids from collecting in the lungs.

Answer 2

Definition

A chest tube is a hollow, flexible tube in the chest. It acts like a drain.

• Chest tubes drain blood, fluid, or air from around your lungs. This allows your lungs to fully expand.
• The tube is placed between your ribs and into the space between the inner lining and the outer lining of your lung. This is called the pleural space.

Alternative Names

Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy

Description

When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head.

• The area where the tube will be inserted is numbed. Sometimes you will receive medicine through a vein (intravenous, or IV) to make you relaxed and sleepy.
• Your skin where the tube will be inserted will be cleaned.
• The chest tube is inserted through a 1-inch cut in your skin between your ribs. Then it is guided to the correct spot.
• The tube is connected to a bottle or canister. Suction is often used to help it drain. Other times, gravity alone will allow it to drain.
• A stitch (suture) and tape keep the tube in place.

After your chest tube insertion, you will have a chest x-ray to make sure the tube is in the right place.

The chest tube usually stays in place until x-rays show that all the blood, fluid, or air has drained from your chest and your lung has fully re-expanded.

The tube is easy to remove when it is no longer needed. Most people do not need medicine to relax or to numb the area when it is removed.

Some people may have a chest tube inserted that is guided by x-ray or ultrasound. If you have major lung or heart surgery, a chest tube will be placed while you are under general anesthesia (asleep).

Why the Procedure Is Performed

Chest tubes are used to treat conditions that can cause a lung to collapse. Some of these conditions are:

• After surgery or trauma in the chest
• Air leaks from inside the lung into the chest (pneumothorax)
• Fluid buildup in the chest (called a pleural effusion) due to bleeding into the chest, buildup of fatty fluid, abscess or pus buildup in the lung or the chest, or heart failure

Risks

Some risks from the insertion procedure are:

• Moving the tube by accident (this could damage tissue around the tube)
• Bleeding or infection where the tube is inserted
• Buildup of pus
• Improper placement of the tube (into the tissues, abdomen, or too far in the chest)
• Injury to the lung, which could cause more breathing problems
• Injury to organs near the tube, such as the spleen, liver, stomach, or diaphragm

After the Procedure

You will usually stay in the hospital until your chest tube is removed. People do not usually go home with a chest tube.

While the chest tube is in place, your nurses will carefully check for air leaks, breathing problems, and if you need oxygen. They will also make sure the tube stays in place. Your nurses will tell you whether it is okay to get up and walk around or sit in a chair.

What you will need to do:

• Breathe deeply and cough often (your nurse will teach you how to do this). Deep breathing and coughing will help re-expand your lung, help with drainage, and prevent fluids from collecting in your lungs.
• Be careful there are no kinks in your tube. The drainage bottle should always sit upright and be placed below your lungs. If it is not, the fluid or air will not drain and your lungs cannot re-expand.

Get help right away if:

• Your chest tube comes out or shifts
• The tubes become disconnected
• You suddenly have a harder time breathing or have more pain

Outlook (Prognosis)

The outlook depends on the reason a chest tube is inserted. Pneumothorax usually improves if the lungs are not sick. In cases of infection, the patient improves when the infection is treated, although sometimes scarring of the lining of the lung can occur (pleural fibrosis).

Reviewed By

Review Date: 03/03/2012

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.