Chest Tube Insertion Made easy (Step by step)http://jacknaimsnotes.blogspot.com/2010/01/chest-tube-insertion.html

IndicationPneumothoraxMassive pleural effusionEmpyemaTraumatic HaemopneumothoraxPost operative procedure.

Preparation

Trolley with dressing pack, chest tube set and suture set.20mL 1% lidocaineScalpel (N15)Chest drain (10-14 F, 0r 28-30F for trauma case)Underwater drainage bottleConnecting tubesSuture materials.

Location (Safety triangle)

4th to 6th intercostals spaceAnterior to mid axillary line

Procedures;

1) Prepare the trolley, drainage bottle and other necessary stuff.

2) Locate the safe triangle

3) 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.

4) Swab the safe triangle with poviderm

5) Let it dry for a while

6) Put cover to maintain the incision field

7) Make 2cm incision above 6th rib to avoid neurovascular bundle below 5th rib.

8) Puncture pleura with scissor or forceps

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

10) Insert chest tube with guide of trochar. Make sure you already clamp the tube first except in pneumothorax only.

11) Remove the metal trochar and advance the tube until feel resistance.

12) Attach the drain to the underwater seal via tubing.

13) Then release the clamp. You can see the blood is flowing.

14) Ensure that longer tube is under water and you can see the bubbling with patient's inspiration.

15) Suture the incision area with mattress or just across the incision site.

16) Fix the drain with second suture tied around the tube like 'Roman gaiter' (Pursed String)

17) Remove the clothes.

18) Clean the blood at incision site.

19) Put gauze on incision site

20) Secure the drain with tape to prevent it from slipping

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

Complication1) Thoracis or abdominal organ injury2) Damage to long thoracis nerve.

Beware of1) 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.

Thank you...Reference:Oxford Handbook of Clinical Medicine 7th edition.

Special thanks to1) Dr Ibrahim A&E Department2) Patient.