Chest tube


A chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum.

Chest tubes are used to remove air, fluid or pus from the intrathoracic space.


Pleural effusion-fluid, blood, chyle


Chest tubes are usually attached to an underwater seal, below the level of the chest, allowing air or fluid to escape from the pleural space, and prevents anything returning to the chest.

Pneumothorax: accumulation of air or gas in the pleural space.

Pleural effusion: accumulation of fluid in the pleural space.

Chylothorax: a collection of lymphatic fluid in the pleural space.

Empyema: a pyogenic infection of the pleural space Hemothorax: accumulation of blood in the pleural space.

Hydrothorax: accumulation of serous fluid in the pleural space.

Contraindications to chest tube placement: coagulopathy and presence of a diaphragmatic hernia, as well as hepatic hydrothorax, pleural adhesions.

The most common complication of a chest tube is chest tube clogging.

Clogging can lead to retained blood around the heart and lungs that can contribute to complications and mortality.

A common complication after thoracic surgery that arises within 30–50% of patients are air leaks.

Digital chest drainage systems can monitor intra-pleural pressure and air leak flow, constantly.

Complications of tube insertion: hemorrhage, infection, and reexpansion pulmonary edema.

Incorrect placement may result in injury to the liver, spleen, diaphragm, thoracic aorta and heart.

Minor complications with a chest tube include subcutaneous hematoma, or seroma, anxiety, shortness of breath, and cough.

Cough is common after removing large volume of fluid.

Chronic pain related to chest tube induced scarring of the intercostal space is not uncommon.

If subcutaneous emphysema occurs, it indicates backpressure created by undrained air.

Subcutaneous emphysema is often caused by a clogged drain or insufficient negative pressure.

Size of chest tubes:

Adult male = 28–32 Fr

Adult female = 28 Fr

Child = 18 Fr

Newborn = 12–14 Fr

Chest tubes are commonly made from clear plastics like PVC and soft silicone, and range of sizes measured by their external diameter from 6 Fr to 40 Fr.

Chest tubes have multiple drainage holes in the section of the tube which resides inside the patient, as well as distance markers along the length of the tube, and a radiopaque stripe which outlines the first drainage hole.

Available chest tubes include: right angle, trocar, flared, and tapered configurations for different drainage needs.

Some chest tubes are coated with heparin to help prevent thrombus formation.

Chest tubes have a proximal end hole, and a series of side holes.

The number of side holes is generally 6 on most chest tubes.

In chest tubes designed for pediatric heart surgery, the chest tube is shorter, and generally by only having 4 side holes.

A chest drainage system is typically is used to collect chest drainage of air, blood, and effusions.

Drainage systems use three chambers which are based on the three-bottle system.

The first chamber allows drained fluid from the chest to be collected.

The second chamber serves as a “water seal”, allowing gas to escape, but not to reenter the chest.

Air bubbling through the water seal chamber is usual when the patient coughs or exhales, and may indicate a pleural or system leak that should be evaluated.

The third chamber is the suction control chamber, where height of the water in this chamber regulates the negative pressure applied to the system.

Bubbling through the water column minimizes evaporation of the fluid and indicates that the suction is being regulated to the height of the water column.

Newer drainage systems use a mechanical check-valve, or a mechanical regulator to regulate the suction pressure.

Newer systems are smaller and more ambulatory so the patient can be sent home for drainage if indicated.

Digital or electronic chest drainage systems can monitor the patient and will alert if the measured data are out of range.

Digital drainage systems allow early mobilization,even for those on continuous suction, which is difficult to accomplish with the traditional water-seal system under suction.

It is recommended the tube be inserted in a region bordered by: the lateral border of pectoralis major, a horizontal line inferior to the axilla, the anterior border of latissimus dorsi and a horizontal line superior to the nipple.

The tube is inserted into the 5th intercostal space slightly anterior to the mid axillary line, and usually inserted under local anesthesia.

The tube is sutured in place and a dressing is applied to the area.

The tube remains as long as there is air or fluid to be removed.

At the completion of open cardiac procedures, chest tubes are placed near the inferior aspect of the sternotomy incision.

Multiple drains may be used to evacuate the mediastinal, pericardial, and pleural spaces.

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