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Chest tubes are placed to drain air, blood, or fluid from the pleural cavity (the space between the chest wall and the lungs).
In addition to being used for drainage, a chest tube, a thin plastic tube, can also be used to administer medications. The tip of the tube (which has drainage holes) is inserted through the skin, usually on the side of the chest, into the pleural cavity. The tubing and the other end of the tube exits from the chest and is attached to a drainage system. The size and type of chest tube and drainage system depends on the reason that a patient needs a chest tube.
Reasons for chest tube insertion include but are not limited to
Pneumothorax: air leakage into the pleural cavity, which causes the lung to collapse
Hemothorax: blood in the pleural cavity, which may be from injury to the chest
Pleural effusion: fluid in the pleural cavity, which includes simple fluid (an uninfected collection of fluid around the lung due to inflammation from underlying pneumonia), pus (empyema), or lymph (chylothorax)
Pleurodesis: a procedure that involves placing medications into the pleural cavity and that may be used for pneumothorax that does not respond to usual treatment or pleural effusions
Postoperative care: Patients who have surgery on the chest may have a chest tube placed after the surgery.
Chest tubes are usually placed after local numbing medication is given. An incision is made, often on the side of the chest, and the tube is inserted through this incision. The tube is sutured in place and airtight dressings are placed over the incision and tube. The tube is then connected to a drainage device, which may be connected to a suction device. This procedure may be painful, although the pain can be minimized by local numbing medication along with pain medication given as pills or as an injection. If you are having surgery on your chest, you will likely have the chest tube(s) placed at the end of your surgery, while you are still in the operating room.
Complications from chest tube insertion are low, although they are higher in the setting of chest trauma. Risks of chest tube insertion include but are not limited to bleeding, pneumothorax, and injury to the structures in the chest. Your doctor will discuss the risks with you before chest tube placement.
After a chest tube is placed, patients usually stay in the hospital, and nurses and doctors check the tube to make sure it is working properly (for example, they will check that air leaks or blockages in the tubing have not occurred). Sometimes patients are able to go home with a chest tube. If this is the case, a smaller device may be connected to the end of the chest tube, and nurses or doctors will teach you how to care for your chest tube at home.
Your doctor determines when it is safe to remove the chest tube. This timing depends on the reason for the chest tube placement and on the speed of recovery. A chest tube can be removed at the bedside in the hospital or in an outpatient clinic. Often, patients need a chest x-ray after the chest tube is removed.
American Thoracic Societywww.thoracic.org/patients/patient-resources/
American College of Chest Physicianswww.chestnet.org/Publications/Other-Publications/Patient-Education-Guides
Conflict of Interest Disclosures: None reported.
Sources: Cassivi SD, Deschamps C, Pastis NJ. Chest tube insertion and management. In: Spiro SG, Silvestri GA, Agustí A, eds. Clinical Respiratory Medicine (Fourth Edition). Elsevier; 2012:chap 72.
Santhosh L, Broaddus VC. Chest tube complications. Patient Safety Network website. https://psnet.ahrq.gov/webmm/case/411/chest-tube-complications. Published June 2017. Accessed June 1, 2019.
Graham DS, Livingston EH. Chest Tubes. JAMA. 2019;322(8):792. doi:10.1001/jama.2019.8842
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