Chest Tube Insertion and Guide

1. Chest Tube Insertion &
Central Venous Line
Dr Adib Mursyidi Iskandar Mirza
Emergency Department
IIUM Medical Centre

2. What is Chest Tube?
• Tube thoracostomy is the insertion of a tube (chest tube) into the
pleural cavity to drain air, blood, bile, pus, or other fluids.

3. Indication
• Pneumothorax: Open or closed; simple or tension
• Hemothorax
• Hemopneumothorax
• Hydrothorax
• Chylothorax
• Empyema
• Pleural effusion
• Patients with penetrating chest wall injury who are intubated or about to be
intubated
• Considered for those about to undergo air transport who are at risk for
pneumothorax

4. Contraindication
• 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

5. Equipment
• Chest tube drainage device with water seal
(autotransfuser unit is an option)
• Suction source and tubing
• Sterile gloves
• Preparatory solution
• Sterile drapes
• Surgical marker
• Lidocaine 1% with epinephrine
• Syringes, 10-20 mL (2)
• Needle, 25 gauge
• Needle, 23 gauge
• Blade, No. 10, on a handle
• Large and medium Kelly clamps
• Large curved Mayo scissors
• Large straight suture scissors
• Silk or nylon suture, 0 or 1-0
• Needle driver
• Vaseline gauze
• Gauze squares, 4 x 4 in (10)
• Sterile adhesive tape, 4 in wide
• Chest tube of appropriate size: Man - 28-32F;
woman - 28F; child - 12-28F; infant - 12-16F;
neonate - 10-12F

6. Anatomy

7. Central
Venous Line

8. Central Venous Line
• This procedure can be associated with significant complications
and must always be performed under supervision until
competence is attained.
• Commonly used sites
• Internal jugular vein (IJV), subclavian vein and femoral vein, which are all
located close to arteries and nerves that can be damaged by a misplaced
needle
• In addition the subclavian vein lies near the pleura of the lung
with the risk of pneumothorax

9. Indications
• Intravenous administration of specific drugs (e.g. dopamine or
adrenaline)
• Inability to obtain adequate peripheral IV access in the critically
unwell patient, in a timely fashion
• Haemodialysis
• Central venous pressure monitoring, the insertion of a pulmonary
artery (Swan-Ganz) catheter to measure wedge pressure
• Hyperalimentation (TPN administration)
• Cardiopulmonary resuscitation.

10. Contraindication
• Less invasive forms of IV access are possible and adequate
• Overlying skin lesion such as cellulitis or burns
• Uncorrected bleeding diathesis
• Obstruction of the vein by tumour, mass or thrombosis
• Uncooperative patient.

11. Anatomy

12. Guidewire Insertion Length

13. Questions?

14. Thank you