Tube thoracostomy, commonly known as chest tube placement, is
the insertion of a tube into the pleural space typically to drain
air or fluid, although the procedure may be performed for pleurodesis
or lysis of adhesions in the pleural space.
- ▪ Pneumothorax: Accumulation of air in the pleural space
- ▪ Pleural effusion: Accumulation of fluid in the pleural
- ▪ Pleurodesis: Medical treatment for refractory pleural effusion
(often malignant) or pneumothorax in which a chemical is instilled
into the pleural space to adhere the pleural and pulmonary surfaces
to one another
- ▪ There are a variety of indications for tube thoracostomy.
- —Aspiration of air from a pneumothorax or with
- —Therapeutic drainage of serous, infected, or malignant
fluid from the chest
- —Postoperative drainage of the chest following thoracic
or cardiac surgery
- ▪ Contraindications.
- —Pleural adhesions
- ▪ The patient should be consented, prepped, and the
universal protocol performed as in Section I.
- ▪ The patient is typically positioned on supine with the
arm abducted over the head (Figure 32-1) for tube insertion in the
mid-axillary line, although alternative positions may be appropriate.
- ▪ Local anesthesia is instilled into the area of insertion
- ▪ A small 2-cm incision is made.
- ▪ The appropriate tube is inserted depending on the pathology.
- —Pneumothorax—small bore tube (ie,
- —Fluid drainage—large bore tube (ie, 18
and above French)
- ▪ Small tubes can be inserted using Seldinger technique.
- ▪ Larger tubes are inserted using blunt dissection (Figures 32-3, 32-4, and 32-5).
- ▪ If blunt dissection is used, a hemostat is used to guide
the tube into the thoracic cavity (Figure 32-6).
- ▪ The tube should be directed appropriately depending on
the nature of the pathology, that is, cephalad for a pneumothorax
(Figure 32-7) or posteriorly and inferiorly for an effusion.
- ▪ The chest tube should be attached to a drainage system
and monitored for ongoing fluid drainage and air leak.
- ▪ A chest x-ray should be performed following the procedure
to ascertain tube position (Figure 32-8).
Draped and prepped incision site in med-axillary line.
Skin infiltration with local anesthetic.
Widening of pleural opening with hemostat.
Tube guided into pleural space with hemostat.