Mr. Ibrahem/Chest tube | |
---|---|
Other names | Intercostal drain, chest drain, thoracic catheter, tube thoracostomy, intercostal catheter, Bülau drain |
Specialty | Emergency medicine, general surgery |
Complications | Subcutaneous emphysema, blockage of the tube, bleeding, infection, reexpansion pulmonary edema, lung or diaphragm injury[1] |
A chest tube is a flexible plastic tube that is inserted through the chest wall into the pleural space.[1] It is used to remove air (pneumothorax), fluid (pleural effusion, hemothorax), or pus (empyema).[1] In those with a tension pneumothorax, a needle thoracostomy may be carried out first.[1]
The person is generally placed on their back, possibly with the head of the bed raised, and their hand behind their head.[2] After the area is cleaned with chlorhexidine and injected with local anesthetic, a 2 cm horizontal incision is make at the 4th or 5th intercostal space anterior axillary line.[2] Kelly forceps are than used to dissect one intercostal space up and into the pleura.[2] A finger may be placed in the hole to help guide in the chest tube.[2] The tube is aimed superiorly for air and inferiorly for fluid.[2] The tube is than sutured, gauze applied, and taped.[2] It is than connected to a drainage system.[2]
In a pneumothorax bubbles will be seen in the drainage system.[2] A chest X-ray is than carried out to confirm placement.[2] The tube may be removed once air leakage has stopped for more than 12 to 24 hours or the amount of fluid out is under 200 ml per 24 hours.[2] Removal should occur when the person has taken and is holding a maximal breath.[2] Another chest X-rays is done after 12 to 24 hours.[2] Complications may include subcutaneous emphysema, blockage of the tube, bleeding, infection, reexpansion pulmonary edema, and lung or diaphragm injury.[1]
A chest tube was first used by Hippocrates around 400 BC to drain an empyema using a metal tube.[3][4] The addition of water seals came about in 1873.[5] Chest tubes became widely used in the 1920s, for post-pneumonic empyema as a result of the 1918 influenza pandemic.[5] Modern tubes sizes vary from 6 to 40 French (Fr) and are made from either silicone or polyvinyl chloride.[5] They generally have a number of holes at one end and a stripe along the side that appears bright on X-rays.[6]
References edit
- ^ a b c d e f "How To Do Tube and Catheter Thoracostomy - Pulmonary Disorders". Merck Manuals Professional Edition. Archived from the original on 14 August 2022. Retrieved 9 August 2022.
- ^ a b c d e f g h i j k l m n o p q r s t Dev SP, Nascimiento B, Simone C, Chien V (October 2007). "Videos in clinical medicine. Chest-tube insertion". The New England Journal of Medicine. 357 (15): e15. doi:10.1056/NEJMvcm071974. PMID 17928590. S2CID 73173434.
- ^ M, Sriram Bhat (30 November 2017). SRB's Surgical Operations: Text & Atlas. JP Medical Ltd. p. 203. ISBN 978-93-5270-211-4. Archived from the original on 14 August 2022. Retrieved 10 August 2022.
- ^ Hippocrates (1847). Genuine Works of Hippocrates. Sydenham Society.
- ^ a b c Wahidi, Momen M.; Ost, David E. (5 July 2022). Practical Guide to Interventional Pulmonology. Elsevier Health Sciences. p. 165. ISBN 978-0-323-70955-2. Archived from the original on 14 August 2022. Retrieved 10 August 2022.
- ^ Ravi, C; McKnight, CL (January 2022). "Chest Tube". PMID 29083704.
{{cite journal}}
: Cite journal requires|journal=
(help)