Overview

Chest Tube Insertion is a critical procedure used to drain air, blood, or fluid from the pleural space. It is essential for treating pneumothorax, hemothorax, and pleural effusions.

Chest tube insertion is crucial for treating life-threatening conditions like tension pneumothorax, massive hemothorax, and large pleural effusions. It can be lifesaving in emergency situations.

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Indications

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Pneumothorax

Tension or large pneumothorax

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Hemothorax

Blood in pleural space

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Pleural Effusion

Large symptomatic effusions

✓
Empyema

Infected pleural fluid

✓
Post-operative Drainage

After thoracic surgery

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncorrected coagulopathy

Relative Contraindications

✗ Previous chest surgery
✗ Adhesions
✗ Small pneumothorax

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, sterile technique setup, monitoring equipment, and emergency backup. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient, prepare sterile field.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning
  • Incomplete sterile prep

💡 Pro Tip:

Position patient with arm abducted for access.

Step 2: Site Selection

Choose insertion site (4th-5th intercostal space, mid-axillary line).

⚠️ Common Mistakes to Avoid:

  • Wrong site selection
  • Too high or low

💡 Pro Tip:

Use anatomical landmarks for proper site selection.

Step 3: Local Anesthesia

Infiltrate local anesthetic at insertion site.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Anesthetize skin, subcutaneous tissue, and pleura.

Step 4: Skin Incision

Make 2-3 cm incision over rib.

⚠️ Common Mistakes to Avoid:

  • Incision too small
  • Wrong location

💡 Pro Tip:

Make incision over rib to avoid neurovascular bundle.

Step 5: Blunt Dissection

Dissect through subcutaneous tissue to pleura.

⚠️ Common Mistakes to Avoid:

  • Inadequate dissection
  • Vascular injury

💡 Pro Tip:

Use blunt dissection to avoid vascular injury.

Step 6: Pleural Entry

Enter pleural space, confirm with finger.

⚠️ Common Mistakes to Avoid:

  • Wrong entry
  • Lung injury

💡 Pro Tip:

Always confirm pleural entry with finger before tube insertion.

Step 7: Tube Insertion

Insert chest tube, connect to drainage system.

⚠️ Common Mistakes to Avoid:

  • Wrong tube size
  • Poor positioning

💡 Pro Tip:

Direct tube posteriorly and superiorly for air, inferiorly for fluid.

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Post-procedure Care

Post-procedure care involves monitoring tube function, daily dressing changes, chest X-ray confirmation, and timely removal when drainage decreases.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 2-5% Excessive bleeding, hypotension Pressure, exploration if needed Proper technique, avoid vessels
Lung injury 1-3% Hemoptysis, increased air leak Monitor, chest X-ray Careful technique, finger confirmation
Infection 3-8% Erythema, purulent discharge Antibiotics, tube removal Sterile technique, proper care
Tube dislodgement 5-10% Loss of drainage, subcutaneous air Reinsertion if needed Proper securing, patient education

Clinical Pearls

💡

Always confirm pleural entry with finger before tube insertion.

🎯

Use anatomical landmarks for proper site selection.

⚡

Direct tube posteriorly for air, inferiorly for fluid.

🔍

Always confirm placement with chest X-ray.

📊

Use sterile technique throughout the procedure.

🎨

Secure tube properly to prevent dislodgement.

⚠️

Monitor for complications post-procedure.