It is a small incision of the chest wall, with maintenance of the opening for drainage. It is most often used to treat a pneumothorax .
It is a minimally invasive procedure performed to drain fluid, blood, or air from the space around the lungs to prevent lung collapse.
A thin plastic tube is inserted into a space called the pleural space, the area between the chest wall and the lungs, and excess fluid or air is removed from that space. A thoracostomy in the chest can also be used to inject medicine.
This is done by surgeons, emergency department doctors, and paramedics, usually through a needle thoracostomy or with a thoracostomy tube ( chest tube ).
A thoracostomy is often confused with a thoracotomy, which is a larger incision commonly used to gain access to organs within the chest.
When air, blood, or other fluids collect in the pleural cavity, it can be drained through a thoracostomy. While air in this space (pneumothorax) can be released through a needle thoracostomy, other substances require drainage with a thoracostomy tube.
Chest tube thoracostomy is done for the following reasons:
To resolve pneumothorax (collapsed lung), when air or fluid builds up in the pleural space due to various lung diseases, such as trauma, cystic fibrosis, chronic obstructive pulmonary disease, asthma, or lung cancer .
Also to resolve the hemothorax, where blood accumulates in the pleural space. For use in empyema, where there is an infection in the pleural space with a collection of pus. To be used for pleural effusion, where there is excess fluid due to lung tumors, heart failure, pneumonia, or tuberculosis.
There are no absolute contraindications to thoracostomy. There are relative contraindications (such as coagulopathies); however, in an emergency situation, these are offset by the need to re-inflate a collapsed lung or drain fluid from the lungs.
What preparations are necessary before the procedure?
The following preparations may be necessary before a chest thoracostomy procedure:
The physician may evaluate the individual’s medical history to obtain a comprehensive understanding of the patient’s general health, including information related to medications currently being taken.
Tell your healthcare provider if you have a history of any medical conditions, such as heart disease, asthma, diabetes, or kidney disease.
Inform your healthcare professional of any allergies, especially related to barium or iodinated contrast material, that may be used in the procedure.
It is advisable to wear comfortable and loose clothing. Avoid wearing metal objects or jewelry, as they can interfere with the scan. It is strongly recommended that you inform your healthcare professional if you are pregnant or breastfeeding.
Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, prior to the preparation sessions.
An ultrasound is not recommended if the patient has had a barium enema or IG test in the past two days. This is because any residual barium in the body can affect the ultrasound test.
The patient may be asked to avoid eating or drinking for several hours before the test. The patient may be asked to stop taking blood thinners, such as aspirin, non-steroidal anti-inflammatory drugs, before the procedure.
The surgeon drains the pleural cavity by making a primary incision in the skin followed by a second incision through the muscle between the ribs. In this way, a tube can be guided into the chest to allow for drainage.
The chest tubes are designed to collect this drainage and prevent anything from leaking into the pleural space. This is accomplished by a check valve, usually part of a specialized drainage system with an underwater seal.
Depending on the amount of air / fluid to be drained, the collection bottle may need to be changed periodically.
The chest thoracostomy procedure can be performed using an ultrasound or CT scan, depending on individual circumstances.
The chest thoracostomy procedure is performed as follows:
The patient is placed on the examination table, after receiving medications for nausea and pain. An intravenous (IV) line is inserted into the patient’s arm to inject medicine or anesthesia.
The catheter insertion area is cleaned and sterilized. The catheter is inserted through the skin and, using image guidance from CT or ultrasound, is sent to the treatment site in the pleural cavity.
An x-ray is taken to verify correct placement of the chest tube. A chest tube is attached to the drainage (vacuum) system and excess fluid, blood, or air is drained from the chest and the lungs are fully expanded.
The patient will be asked to take a deep breath to expand his lungs. Lung capacity is tested after removing the fluid using a spirometer.
After the chest tube is removed, bandages or sutures can be applied and the patient can leave the hospital after a short observation period, the same day.
Risks / complications
Complications are mainly due to the placement technique, inexperience of the physician, and emergent versus elective circumstances. The most common complications are recurrent pneumothorax (incomplete recovery), infection, and organ injury (due to mechanical damage).