Emergency Medicine Book


Chest Tube

Aka: Chest Tube
  1. Indications
    1. Tension Pneumothorax
    2. Simple Pneumothorax
    3. Open Pneumothorax
    4. Massive Hemothorax
  2. Equipment
    1. Size #34 French Chest Tube (#38 F for Hemothorax)
    2. Chest Tube Suction Apparatus or pleur-evac
  3. Technique
    1. Insertion Site
      1. Level of 5th intercostal space, over 6th rib
        1. Nipple level in men, inframammary fold in women
      2. Insert anterior to mid-axillary line
    2. Preparation
      1. Betadine prep and drape
      2. Lidocaine 1% local anesthetic to skin and rib
    3. Insertion Procedure
      1. Incise Horizontally 2-3 cm over the 6th rib
      2. Bluntly dissect through subcutaneous tissue over rib
      3. Carefully puncture parietal pleura with clamp tip
      4. Insert finger into incision and make 360 degree sweep
        1. Check for organs, adhesions and enlarge path
      5. Insert chest tip with clamp
      6. Look for tube condensation indicating good placement
    4. Procedure Completion
      1. Suture tube in place
      2. Attach Chest Tube to suction
        1. Underwater seal apparatus and suction (-20 cm H2O)
        2. Pleur-evac
      3. Chest XRay
        1. Verify position and function of tube

Chest Tubes (C0008034)

Definition (MSH) Plastic tubes used for drainage of air or fluid from the pleural space. Their surgical insertion is called tube thoracostomy.
Concepts Medical Device (T074)
MSH D015505
English Chest drain, Chest Tube, Chest Tubes
Spanish drenaje toracico
Parent Concepts Surgical Equipment (C0038923), Drain device (C0180499), Cardiothoracic device (C0581398)
Derived from the NIH UMLS (Unified Medical Language System)

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