From the Guidelines
The chest tube insertion procedure involves several key steps, including obtaining informed consent, gathering necessary equipment, positioning the patient, identifying the insertion site, preparing the site, administering local anesthetic, making an incision, puncturing the pleura, guiding the chest tube into the pleural space, securing the tube, and connecting it to a drainage system, as recommended by the most recent and highest quality study 1. The procedure is essential for treating pneumothorax, hemothorax, pleural effusions, and empyema by restoring negative pressure in the pleural space and allowing for drainage of air or fluid. Some key considerations for the procedure include:
- Using a single chest drain for management of postoperative pleural effusion, as recommended by 1
- Using a digital chest drainage system for suction drainage, as recommended by 1
- Removing the chest drain as soon as possible, or when air leaks are no longer observed and when serous pleural drainage is <300 mL/day, as recommended by 1
- Providing good quality preoperative information using multiple supports, as recommended by 1
- Considering a preoperative prehabilitation programme in at-risk patients, as recommended by 1 The choice of drainage procedure depends on local expertise, and both chest thoracostomy tube drainage with the addition of fibrinolytic agents and VATS have been demonstrated to be effective methods of treatment, as recommended by 1. However, in patients with moderate-to-large effusions that are free flowing (no loculations), placement of a chest tube without fibrinolytic agents is a reasonable first option, as recommended by 1. It is also important to note that small, uncomplicated parapneumonic effusions should not routinely be drained and can be treated with antibiotic therapy alone, as recommended by 1. Overall, the chest tube insertion procedure is a critical intervention for patients with pneumothorax, hemothorax, pleural effusions, and empyema, and should be performed with careful attention to detail and adherence to established guidelines, as recommended by the most recent and highest quality study 1.
From the Research
Steps for Chest Tube (Thoracostomy) Procedure
The steps for a chest tube procedure involve several key considerations, including:
- Indications for chest tube insertion, such as drainage of large exudative pleural effusions, empyemas, hemothoraces, or chylothoraces, and for some pneumothoraces or parapneumonic effusions 2
- Choice of chest tube size, with small-bore chest tubes (≤14F) generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general 3
- Technique for chest tube insertion, with the incisional method being safest, and the use of blunt dissection or the Seldinger technique instead of the trocar technique 2, 3
- Connection of the chest tube to a drainage system device, such as a flutter valve, underwater seal, electronic systems, or vacuum bottles 3
- Management of the chest tube, including the use of suction or water seal drainage, and the optimal timing for tube removal 3, 4
Pre-Procedure Considerations
Before performing a chest tube procedure, it is essential to:
- Correct any coexisting hemorrhagic disorders, if time allows 2
- Consider the patient's characteristics and the operative procedures that had been performed 4
- Use imaging guidance, such as bedside ultrasonography or computed tomography, to guide chest tube insertion 3
Post-Procedure Management
After the chest tube procedure, it is crucial to:
- Monitor the patient's condition and the chest tube's function closely 4, 5
- Manage the chest tube based on careful observation, the patient's characteristics, and the operative procedures that had been performed 4
- Remove the chest tube when appropriate, using a technique that minimizes complications 4, 5