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Chest Tube


Chest tube indications 1. Symptomatic pneumothorax 2. Haemothorax 3. Chylothorax 4. Empyema 5. Post thoracotomy 6. Positive pressure ventilation prophylactically ex. flail segment
Which fluid would you NOT want to drain in a chest tube? Pleural effusion. Do thoracocentesis
What is the danger of a thoracostomy tube being used in pleural effusion? Re-expansion pulmonary oedema
How do you place chest tube?
How do you place a chest tube? 1. Choose position 2. Infiltrate LA to skin, IC muscles 3. Incise area 4. use blunt dissection to dissect muscles 5.
Where do you place a chest tube? Between mid axillary and anterior axillary line in 5th ICS, along superior border of inferior rib on affected side. Lowest on R is 5th, lowest on L is 7th
Where should the tip of tube be? Posterior aspect of basal part of lung for fluid. In trauma, haemothorax usually accompanies pneumo
How much haemothorax is present before it is seen on CXR? 300-500mL
What monitoring do you do after placing chest tube? Monitor drainage to determine if there is need for thoracotomy. 1. More than 1L STAT 2. More than 200 mL/hr in 4 hrs Drainage calculated by subtracting 300 mL (underwater seal) from value on graduation
How would you Mx a pt with a thoracostomy tube? Chest X ray to confirm proper placement 1. Analgesia 2. Physiotherapy 3. Antibiotics (depending on what inflicts injury)
How much fluid is required for UW seal? 2cmH20/300 mL usually
How do you know when chest tube is no longer needed? Clinically: minimal oscillation, minimal drainage, bilateral full lung expansion on examination Radiologic: Chest Xray noting full re-expansion
If you had no CXR, what method could you use to determine if it is time to remove tube? May do a trial without underwater seal. Clamp thoracostomy tube, and monitor patient for 1 hour. If patient is comfortable and there remains clinical signs of re-expansion, may take out the tube.
How do you remove a chest tube? After satisfying removal criteria, remove sutures securing tube, and ask patient to hold their breath at maximal inspiration, at which point the tube should be removed and the sutures drawn tightly. Then get a CxR to ensure no iatrogenic pneumothorax
what would you do if it was reported that there was continuous bubbling in the underwater seal? 1. Check for air leak *check chest wall, tube connections) 2. Bronchopleural fistula
How do you treat a bronchopleural fistula? Place the chest cavity on suction under controlled pressure. this allows re-expansion of the lung while the bronchopleural fistula heals
how would you place suction in BP fistula? Add 2nd bottle, place under suction at pressure of 12-15 cmH20. (in middle tube)
What if suction fails to heal the BP fistula? Surgically Mx BP fistula (thoracoscopy or thoractomy)
What are the indications for pleurodesis? 1. Malignant effusion (most common) 2. Recurrent spontaneous pneumothoraces
How is pleuredesis done? Chemical: Bleomycin, Tetracycline, Talc Surgical
Summarise how a pleurodesis done? p1 release pleural effusion slowly to prevent reexpansion injury. then mix chemical in 50mLs of fluid and inject into chest cavity. Clamp chest tube. Physiotherapist will position the patient in various positions to bathe both pleural surfaces.
Summarise how pleuredesis done p2 then return, remove tube and perform CXR to rule out iatrogenic pneumothorax. Inflammation allows layers to fuse, Both surfaces can b traumatised as well and when healed
How long do you wait b4 surgically treated Bronchopleural fistula/ 1 week else fistula may form between cavity and chest wall.
What size would you choose for a female re chest tube? 28Fr
Size for adult male, chest tube 28-32 Fr
Child chest tube size 18 Fr
Newborn, chest tube, size 12-14 Fr
Created by: IonaDel
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