Chest Tube

Chest Tube Procedure

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:18:00 +0000

Time Out Procedure

Prep the side of the chest with betadine in sterile fashion and drape it.

Using your scalpel make an incision on the anterior axillary line at the 4th or 5th interspace

Make the incision big enough to get your finger in going the same direction as the interspace

Dissect bluntly with your finger down to the ribs with your finger

When your get down to the ribs, you want to go over the rib below with your forceps

Push through the ribs and make a whole with your forceps.

When you get in, you should get a rush or air or blood come out of the hole

Clamp the distal end of your tube and direct the end with the hole up towards the apex.

Hook it up to the suction tubing and suture the chest tube in place.

Place the petroleum gauze around the tube.

Tape the tube in place

Get a Stat portable chest after the procedure

Chest Tube Equipment from Patient to the Wall

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:08:00 +0000

Chest tube (Usually 28-32 for air and 36-40 for blood)
Adhesive tape to secure tube
6 foot tubing
connectors
Pneumovac (the suction drain)

Chest Tube Equipment

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:07:00 +0000

Sterile Towels
Betadine
4 X 4 Guaze Packages
10 mL syringe for local anethesia
Local Anesthetic (Usually lidocaine with or without epinephrine)
Straight suture scissors Large
Needle holder
Sutures (0.0-2.0 usually silk or nylon)
Forceps
Scalpel
Petroleum gauze and tape

Complications of Chest Tube Insertion

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:05:00 +0000

Bleeding
Infection
Visceral Injury
Intercostal nerve or vessel injury
Air Leaks
Subcutaneuous or Mediastinal Ephysema
Reexpansion hypotension, hypoxia, or pulmonary edema
Reoccurence of pneumothorax after chest tube removal.

Chest Tube Relative Contraindications

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:04:00 +0000

Pleural Adhesions, scars, blebs
Recurrent pneumothorax that requires surgical treatment
Need for immediate open throacotomy (loss of vital signs in trauma bay with penetrating chest trauma)
Bleeding diathesis (INR>1.4)

Chest Tube Indications

noreply@blogger.com (Anonymous) — Thu, 02 May 2013 11:03:00 +0000

Pneumothorax (Usually >15%)
Hemothorax
Hemopneumothorax
Emypema
Draining of recurring pleural fluid
Chlyothorax