Indications
- Traumatic Pneumothorax
- Spontaneous Pneumothorax (some)
- hemothorax
- abscess
- empyema
Relative Indications
- rib fractures and positive pressure ventilation
- profound hypoxia/hypotension in patient with penetrating chest injury
- profound hypoxia/hypotension and signs of hemithorax
Contraindications
- overlying skin infection
Equipment Needed
- Chest Tube Tray
- sterile drapes
- silk sutures
- curved clamps
- syringes and needles for anesthesia
- scaple
- Lidocaine
- Betadine
- Sterile gown
- sterile gloves
- face shield
- Chest tube (18-20 French for pneumothorax, 32-26F for hemothorax, 38-40 French for trauma pt)
- Pleura-vac
Procedure
- expose patients lateral thorax by moving the upper extremity above the head on the affected side
- note landmarks to help decide where you will be inserting your tube (lateral thorax, midaxillary line at 4th/5th intercostal space (~nipple line in males or 5cm above the sternoxiphoid junction in females)
- prep skin with betadine and drape with sterile drapes
- confirm the rib space where you are going to insert the tube and anesthetize the area with 10-20cc's of lidocaine w/epinephrine making sure to anesthetize the skin, soft tissues, muscle, periosteum, and pleural space
- Make an incision along the upper border of the lower rib below the intercostal space that you are going to use. **make sure the incision is large enough that your finger can easily go through it
- Using a curved clamp, create a tract by bluntly dissecting the muscle tissue until you reach the rib
- Angle the clamp to go above and over the rib (avoiding intercostal vessels and nerves) and push until you enter the pleural space
- Open the clamp and pull it out with the clamp still open creating a larger tract
- Clamp the end of your chest tube and pass it along the tract into the pleural cavity (it helps if you have your finger in the tract in the space and pass the tube along your finger so you know you're in the right space)
- Once in the space, remove the clamp and feed the chest tube until all the holes are inside the thoracic cavity aiming it toward the apex
- Attach the other end of the chest tube to your pleura-vac and place on suction
- Secure the tube with silk suture (in the kit) and cover with gauze and cloth tape
- re-examine patient to see if you got a desired effect and get a CXR to confirm placement and position of tube
Complications
- bleeding (causing a hemothorax)
- infection
- damage to nerves/vessels/heart/lung/diaphragm/abdomen
- air leak
- improper positioning of the tube
- tension pneumothorax
- failure to drain
Source
http://www.trauma.org/archive/thoracic/CHESTdrain.html
