Chest Tube
last authored: April 2012, David LaPierre
last reviewed:
Introduction
The chest tube is a large-bore catheter placed into the pleural cavity to remove air or fluid.
In the case of chest trauma, a chest tube should be placed as soon as possible, in a location away from the wound. Before this, tape an occlusive dressing with three sides taped down, over the wound.
In the setting of a hemothorax, a chest tube can be used to remove blood, expand the lung, and allow monitoring of blood loss.
Equipment Required
Supplies that are required include:
- local anesthetic
- sedation
- surgical prep: alcohol, betadine, or chlorhexidine
- surgical drapes
- sterile gloves
- mask
- #15 scalpel
- forceps
- chest tube
- suture
- dressing and tape
- suction apparatus
Landmarking
The insertion site is normally the 4th or 5th intercostal space (nipple line), anterior to the midaxillary line.
Procedure
Identify the insertion site, as above. Mark using a fingernail or pen cap.
Don a mask and sterile gloves.
Prep and drape the site, using sterile technique.
Provide local anaesthesia to the skin and rib periosteum, along the superior aspect of the lower rib.
Make a 2-3 cm horizontal incision in the skin.
Using the forceps, bluntly dissect down through the subcutaneous tissues.
Using a clamp, puncture the parietal pleura. Insert a sterile gloved finger.
Clamp the tube and advance it into the pleural space, moving in a posterior direction along the chest wall.
Confirm placement by listening for air movement and looking for fogging.
Manually remove fluid with a large syringe or connect to an underwater-seal apparatus.
Suture the tube in place.
Apply dressing and tape tube in place.
Obtain a chest X-ray to confirm placement.
Monitor vital signs, including pulse oximetry, and arterial blood gases.
Complications
Chest tube placement, if done improperly, can result in significant injury or death. Complications can include:
- laceration of thoracic or abdominal organs
- infection
- damage to artery or vein (and creating a hemothorax)
- damage to nerve (and causing neuralgia)
- persistent pneumothorax
- subcutaneous emphysema
Resources and References
American College of Surgeons. 2004. Advanced Cardiac Life Support manual.
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