Index
It is a thoracic drainage system whose function is to drain air or fluid from the pleural space.
A chest tube (chest drain, chest catheter, tubular thoracostomy, or intercostal drain) is a flexible plastic tube inserted through the chest wall and into the pleural space or mediastinum.
It is used to remove air or fluids from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.
This system allows the pleural pressure to be restored and a collapsed lung to dilate.
By placing an endothoracic tube, this system allows the elimination of the liquid or gaseous content formed in the pleura.
Partes del pleural
- Collection chamber: collects air or liquid.
- Central section: acts as a water seal.
- Regulating chamber: provides vacuum regulation and suction control.
- Drainage unit: includes an automatic valve to lower the pressure and protect the patient from the negative pressure generated.
- Self-sealing diaphragms.
Technique
The insertion technique for emergency pleural drainage is described below:
The free end of the tube is usually attached to an underwater seal below chest level. This allows air or fluid to escape from the pleural space and prevents everything from going back into the chest. Alternatively, the tube can be attached to a vibrating valve. This allows pneumothorax patients to remain more mobile.
The tube should be inserted into the fifth intercostal space slightly anterior to the mid-axillary line.
Chest tubes are usually inserted under local anesthesia. The skin over the insertion area is first cleaned with an antiseptic solution, such as iodine, before sterile drapes are placed around the room.
The local anesthetic is injected into the skin and the muscle, and after the area is numb, a small incision is made in the skin, and a passage is made through the skin and power into the chest.
The tube is placed through this passage. If necessary, patients may receive additional pain relievers for the procedure. Once the line is in place, it is sutured to the skin to prevent falling off, and a dressing is applied to the area. Once the drain is in place, a chest X-ray will be taken to check the location of the gutter.
The tube remains as long as there is air or liquid to eliminate or risk of air accumulation.
Chest tubes can also be placed using a trocar; a pointed metal bar guides the line through the chest wall. This method is less popular due to an increased risk of iatrogenic lung injury.
Postoperative drainage
The placement technique for postoperative drainage (e.g., cardiac surgery) differs from that used for emergencies.
Upon completion of open cardiac procedures, the chest tubes are placed through separate puncture incisions, usually near the bottom of the sternotomy incision.
In some cases, multiple drains can be used to evacuate the mediastinal, pericardial, and pleural spaces. Drainage holes are placed inside the patient, and the chest tube is passed through the incision. Once the line is in place, it is sutured to the skin to prevent movement.
The chest tube is then connected to the drain canister using other lines and connectors and connected to a suction source, typically set to -20 cm of water.
Chest tube management
Chest tubes should be kept free from loops, kinks, and dependent obstructions that can prevent drainage. Chest tubes are generally not clamped except during insertion, removal, or diagnosing air leaks.
Manual manipulation, often called milking, pulling, fan fanning, or tapping, is commonly done to clear chest tube obstructions.
There is no conclusive evidence to show that any of these techniques are more effective than the others, and neither method has been shown to improve chest tube drainage.
Additionally, manipulation of the chest tube has been shown to increase negative pressure, which can be detrimental and painful for the patient. Many hospitals do not allow this type of manual tube manipulation for these reasons.
Chest tube internal flushing can be performed to clear chest tube obstructions using an open or closed technique.
Cleaning the open chest tube involves breaking the sterile environment that separates the chest tube from the drainage canister tube. The inner lumen can be flushed with saline, a second catheter can be inserted into the chest tube, and suction can be used to clear obstructions.
Medical uses
There are cases in which this treatment is usually applied; these include:
- Cardiac surgeries.
- Pleural space infection.
- Presence of lymphatic fluid in the pleural space.
- Accumulation of fluid in the pleural space.
- Collection of air or gas in the pleural space.
- The pool of blood in the pleural space.
What is the drained material?
- Air.
- High-fat lymphatic fluid.
- Blood.
- Juice is associated with or caused by a tumor.
- Pus.
Contraindications
Contraindications to chest tube placement include refractory coagulopathy and the presence of a diaphragmatic hernia and hepatic hydrothorax. Additional contraindications include scarring in the pleural space.
Complications
A common complication after thoracic surgery in 30-50% of patients is air leaks. Here, digital chest drainage systems can provide a remedy as they constantly monitor intrapleural pressure and leakage airflow.
The main insertion complications include hemorrhage, infection, and re-expansion pulmonary edema. Damage to the liver, spleen, or diaphragm is possible if the tube is placed below the pleural cavity. Injuries to the thoracic aorta and heart can also occur.
Minor complications include a subcutaneous hematoma or seroma, anxiety, dyspnea, and cough (after removing a large fluid volume).
In most cases, chest tube-related pain disappears after being removed. However, chronic pain related to chest tube-induced scarring in the intercostal space is not uncommon.
