What causes a chest tube to become occluded or kinked (chest drainage tube)?

From the Guidelines

Chest tube kinking is most commonly caused by improper positioning of the tube, excessive tube length, inadequate securing of the tube to the patient's chest wall, or patient movement that causes the tube to twist, as evident from the BTS guidelines for the management of pleural infection 1. Kinking can occur due to various factors, including:

• Improper positioning of the tube
• Excessive tube length
• Inadequate securing of the tube to the patient's chest wall
• Patient movement that causes the tube to twist
• Compression of the tube between the patient's body and the bed or chair
• Dressings applied too tightly around the insertion site To prevent kinking, it is essential to:
• Properly secure the chest tube with sutures and tape
• Coil excess tubing loosely on the bed, not under the patient
• Position the drainage system below chest level
• Regularly assess the tube's patency for signs of obstruction, such as decreased or absent drainage, subcutaneous emphysema, or respiratory distress
• Use special dressings or fixation devices to hold small catheters and drains in place, as recommended in the BTS guidelines for the management of pleural infection in children 1 Proper chest tube management is crucial to prevent kinking, which can lead to inadequate drainage, pneumothorax recurrence, or fluid accumulation that may compromise respiratory function, highlighting the importance of regular assessment and maintenance of the chest tube 1.

From the Research

Causes of Chest Tube Kinking

• The kinking of a chest tube can be attributed to various factors, including the positioning and securing of the tube 2.
• A study found that the Mac-technique test can detect kinking of the chest tube upon thoracostomy tube placement, suggesting that the tube's positioning and movement can contribute to kinking 3.
• The use of a T-shaped chest tube has been shown to reduce the rate of tube kinking compared to classic chest tubes, implying that the design and type of tube can also play a role in kinking 4.
• However, there is no direct evidence to suggest that chest tube kinking is caused by a specific factor, and it is likely that kinking can occur due to a combination of factors, including patient movement, tube positioning, and securing 5, 6.

Factors Contributing to Chest Tube Kinking

• Patient movement and positioning can contribute to chest tube kinking, as seen in a case where a patient's recurrent pneumothorax was attributed to the kinking of a chest tube 2.
• The type and design of the chest tube can also affect the likelihood of kinking, with T-shaped tubes showing a lower rate of kinking compared to classic tubes 4.
• The technique used for chest tube placement and securing can also impact the risk of kinking, highlighting the importance of proper training and technique 3, 5.