What is tube thoracostomy?
Tube thoracostomy, also known as open chest drainage, is a surgical procedure to drain the collection of pleural fluid, air, blood, or pus from the pleural cavity through a tube inserted in your chest.
The pleural cavity is the space lying between the pleura (visceral and parietal), the two thin layers that surround the lungs. This space contains a small amount of liquid known as pleural fluid, which acts as a lubricant for the expansion and contraction of the lungs during respiration. When there is an excessive collection of pleural fluid or build-up of air, blood, or pus in the pleural cavity, you will start having trouble breathing. In such conditions, tube thoracostomy eases breathing.
Why is a tube thoracostomy performed?
In some situations, such as severe traumatic injuries to the chest, tube thoracostomy becomes an emergency and a life-saving procedure. It is also performed as a pre-planned procedure in certain diseases that cause buildup of fluid or air in the pleural cavity.
Tube thoracostomy is performed if the patient develops:
- Pleural effusion: Excessive collection of pleural fluid in the pleural cavity
- Pneumothorax: Leakage of air in the pleural activity
- Hemothorax: Collection of blood in the pleural cavity
- Hemopneumothorax: Collection of blood as well as air in the pleural cavity
- Hydrothorax: Collection of fluid in the pleural cavity due to organ (liver or heart) failure
- Chylothorax: Collection of lymphatic fluid (chyle) in the pleural cavity
- Empyema: Collection of pus in the pleural cavity.
What are the guidelines for tube thoracostomy management?
Surgeons follow a certain set of rules (guidelines) for any surgical procedure. The guidelines for tube thoracostomy include:
- The patient is screened for clotting or bleeding disorder with certain blood tests.
- If one of the patient’s lungs has been removed (pneumonectomy), the surgeon will consult a cardiothoracic surgeon to drain the post-pneumonectomy space.
- If the chest drain insertion is a pre-planned procedure, the blood-thinning medication, warfarin will be discontinued for a few days before the procedure.
- Prior to commencing chest tube insertion, the surgeon will explain the procedure to the patient and obtain aformal, written consent from the patient or their family.
- The patient will be given a sedative medicine (benzodiazepine or opioid) to make them relaxed throughout the procedure.
- The patient will lie on their back or sit and lean forwards.
- The skin below the armpit will be marked with a pen.
- The surgeon will check if they can draw free air or fluid from the marked area.
- A chest X-ray or an ultrasonography (USG) will be used to select the appropriate site for chest tube placement.
- The marked area will be cleaned with a sterile solution before inserting the chest tube.
- Antibiotics will be started if the patient has accidental injuries.
- An anesthetic will be injected into the marked site prior to insertion of the chest tube,
- Chest tube insertion will be performed without substantial force.
- The chest tube may have valves at its insertion, and it is connected directly to the outside collection chamber, which collects drainage from the chest cavity.
Latest Lungs News
What are the strategies for tube thoracostomy management?
In patients with empyema or pleural effusion, initial removal of 50-200 mL of fluid using a syringe attached to a needle may be done prior to the insertion of the chest tube.
The incision will be made over the rib to minimize the risks of injury to the nerve and blood vessels that follow the lower margin of each rib.
Small-bore drains are recommended, as they are more comfortable than larger-bore tubes. Large-bore drains are recommended for drainage of acute hemothorax and to check for further blood loss.
- The strategies for managing the complications of tube thoracostomy are as follows:
- If the chest tube has been placed too far into the chest, it will be retracted
- If the chest tube goes into the abdominal space, it will be removed.
- If bleeding occurs at the incision site, it will be stopped by pressing on it tightly.
- If bleeding occurs in the chest and does not resolve spontaneously, the chest might be opened (thoracotomy).
- Bleeding in the abdomen which is as result of liver or spleen injury requires emergency opening of the abdomen (laparotomy)
- Persistent pneumothorax or hemothorax might require insertion of a new chest tube.
- If the patient starts coughing or experiences chest tightness, the surgeon will end the procedure.
- Most experts recommend removal of no more than 1-1.5 L of fluid at any one time.
Health Solutions From Our Sponsors
Medscape Medical Reference
"BTS guidelines for the insertion of a chest drain."
Laws D, Neville E, Duffy J.
2003 May;58(Suppl 2):ii53.
Top Tube Thoracostomy Management Strategies Related Articles
Respiratory Illnesses: 13 Types of Lung InfectionsIs your cough caused by a cold, flu, pneumonia or something else? Learn causes of respiratory infection like bronchitis, pneumonia, SARS, Coronavirus COVID-19 bird flu, and more.
COPD Lung SymptomsCOPD is a pulmonary disorder caused by obstructions in the airways of the lungs leading to breathing problems. Learn about COPD symptoms, diagnosis, and treatment options.
How Long Does a Pneumonectomy Take?A pneumonectomy is a type of surgery to remove one of the lungs. It is done as a treatment for cancer, injury, or infection. One lung can provide enough oxygen and remove enough carbon dioxide from the body.
Is Pleurisy Contagious?
Pleurisy or pleuritis is an inflammation of the lining around the lungs. Some of the causes of pleurisy include TB, the flu, heart attack, some forms of arthritis, and lupus. The treatment for pleurisy is generally aimed at the underlying cause of pleurisy.
Lung Cancer SlideshowLearn about lung cancer early warning signs, symptoms and treatments. What causes stage IV lung cancer? Get more information on small cell lung cancer, non-small cell lung cancer, and the diagnosis of lung cancer stages.
Know Your Lung Cancer Facts QuizLung cancer is the number one cause of cancer deaths in both men and women in the U.S. and worldwide. Get the facts about lung cancer with this quiz.
Reasons You're Short of BreathHave you ever found yourself gasping for air after just a short flight of stairs? You may just need to do a bit more exercise, or it could be something more serious.
What Are Lung Segmentectomy and Limited Pulmonary Resection?A lung segmentectomy is a procedure to remove the diseased lung without removing excess normal lung. Lung segmentectomy and limited pulmonary resection are performed due to bonchiectasis, early-stage lung cancer, lung nodules, tuberculosis, and suppurative lesions. Complications include air leakage, bleeding, residual airspace, infection of the pleural space, respiratory failure, and cardiac complications.
Lungs PictureThe lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). See a picture of the Lungs and learn more about the health topic.
Pleural Effusion (Fluid in the Pleural Space)Pleural effusion is a buildup of fluid in the chest or on the lungs. There are two types of pleural effusion, transudate and exudate. Causes of transudate pleural effusion include congestive heart failure, kidney failure, and cirrhosis. Exudate pleural effusion can be caused by malignancy (cancer) or lung infection. Typically, transudate pleural effusion is more easily treatable. Symptoms of pleural effusion include chest pain, pain when breathing, difficulty breathing, and cough. Treatment depends on the source or cause of the pleural effusion.
Pleurisy (Pleuritis)Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.