Tube thoracostomy is the insertion of a tube (chest tube) into the pleural cavity to drain air, blood, bile, pus, or other fluids.
Intercostal Chest Drain Insertion (Tube Thoracostomy)
Intercostal Chest Drain Insertion (Tube Thoracostomy)
Indications
- Pneumothorax : Open or closed; simple or tension
- Hemothorax
- Hemopneumothorax
- Hydrothorax
- Chylothorax
- Empyema
- Pleural effusion
- Palliation of breathlessness in malignant pleural effusions
- To facilitate pleurodesis
Contraindications
- The need for emergent thoracotomy is an absolute contraindication to tube thoracostomy.
- Relative contraindications include the following:
- Coagulopathy
- Pulmonary bullae
- Pulmonary, pleural, or thoracic adhesions
- Loculated pleural effusion or empyema
- Skin infection over the chest tube insertion site
During a chest tube insertion, the doctor must work around several major organs, including the lungs and heart. Potential complications include:
- excessive bleeding
- infection
- injuries to the heart, blood vessels, arteries, or lungs
- perforation (puncturing) of the diaphragm
- punctured lung
A doctor should carefully explain these risks to the individual before the procedure. Ideally, they will avoid putting a chest tube in someone who is taking blood thinners due to the risk of bleeding. However, inserting the chest tube can sometimes be a life-saving, emergency procedure.
Chest Tube Removal
Doctors remove chest tubes when they are no longer necessary, for example when the tube is no longer draining blood or fluid.
They will also remove the tube if it becomes blocked or is not working correctly.
Recovery
Ideally, a person’s symptoms will improve following the use of a chest tube.
People should monitor the incision site for signs of infection while it heals, and inform their doctor as soon as possible if the wound swells, turns red, or starts oozing pus. It is likely that a small scar will remain at the insertion site.
Outlook
A chest tube can be a relatively non-invasive way to access the pleural space to drain fluid or administer medication.
Sometimes, if the chest tube does not resolve a person’s problem, they may need more invasive surgery.
After chest tube removal, a person should follow a doctor’s recommendations on how to care for the incision site.
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