Chest Tube Placement

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A chest tube (chest drain or intercostal drain) is a flexible plastic tube that is inserted through the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intra-thoracic space.

Need to Know

Nice to Know
  • You will be asked to sign a consent form before the procedure is performed
  • Tell your radiologist about any allergies, especially to local or general anesthetics and contrast materials (“x-ray dye”)
  • If you are taking a blood thinner or aspirin product, the physician will instruct you when to stop taking these medications
  • Inform your radiologist if you are pregnant
  • You should plan to have someone take you home after the procedure as you will not be able to drive after sedation
  • Wear comfortable, loose-fitting clothing
  • You will be given a gown to wear during your treatment
  • You can go home after the procedure if vitals are stable
  • Most patients feel minimal discomfort after the procedure

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How Does It Work?

The chest tube is inserted through an incision between the ribs into the chest and is connected to a bottle or canister that contains sterile water. Suction is attached to the system for drainage. A stitch (suture) and adhesive tape keep the tube in place.

The chest tube usually stays in place until x-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed. Most people don't need medications to sedate or numb them while the chest tube is removed. Antibiotics may be used to prevent or treat infection. In certain people, the chest tube may be inserted using a minimally invasive technique guided by x-ray, ultrasound or CT-Scan. You will be asked to sign a consent form before a chest tube placement.

What Happens — Before, During, and After?

A clinical staff member will bring you into the pre-procedure area and ask you to change into a gown. An intravenous (IV) line may be inserted into a vein in your hand or arm. Your doctor will greet you, review the procedure, and answer any questions you may have. You will be brought into the procedure room, and you‘ll be positioned on the procedure table. You will be connected to a monitor for your heart rate, blood pressure, and pulse. The technologist will shave, sterilize, and cover the area of your chest where the chest tube will be inserted with a surgical drape. A local anesthetic is administered to numb the area. Once the area is numb, your doctor will advance the needle into your pleural cavity using image guidance. You may feel some mild pain or pressure as the needle enters the pleural space. Once the tube is in your chest, this will be attached to the system for drainage. A stitch (suture) and adhesive tape keep the tube in place. The chest tube typically in place until imaging studies such as x rays show that air or fluid has been removed from the pleural cavity. This removal of air or fluid will allow the affected lung to fully re-expand, allowing for adequate or improved breathing.

If the patient has a large pneumothorax, he/she may stay in the hospital until the tube is removed. It is common to expect complete recovery from chest tube insertion and removal. During the stay, the medical and nursing staff will carefully and periodically monitor the chest tube for air leaks or if the patient is having breathing difficulties. Deep breathing and coughing after insertion can help with drainage and lung re-expansion.

For small pneumothorax, there is a small a Heimlich Valve attached to the catheter. This Heimlich valve is a one-way valve that allows air to flow out of the chest. Patient is able to go home and return the next day for an x-ray. The tube will be removed once an x ray shows that the air has been removed from the pleural cavity.

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How Should I Prepare?

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or – as you’re doing now- educate yourself about the procedure.

Another important part of your preparation will be guided by your doctor:

  • Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.

Some of your preparation will need to be timed to the procedure:

  • The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions, and will ask if you have any questions.
  • Take your medications as instructed.
  • When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or x-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.
 
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What Should I Bring?

  • Wear comfortable, loose-fitting clothes
  • Wear comfortable shoes
  • A list of your current medications with dosages
  • Avoid bringing jewelry or valuables
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What Are the Benefits and Risks?

The benefits of Chest Tube Placement include:

  • Lung re-expansion
  • Drainage of fluid, including infected fluid
  • Decreased shortness of breath

Risks you should be aware of include:

  • Although chest tube insertion is a commonly used as a therapeutic measure, there are several complications that can develop, including:
  • Bleeding from an injured intercostal artery (running from the aorta)
  • Accidental injury to the heart, arteries, or lung resulting from the chest tube insertion
  • A local or generalized infection from the procedure
  • Persistent or unexplained air leaks in the tube
  • The tube can be dislodged or inserted incorrectly
  • Insertion of chest tube can cause open or tension pneumothorax

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.

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