A chest tube is a flexible plastic tube inserted between the chest wall layers to drain air or fluid from the pleural space. It is used to treat conditions like pneumothorax, pleural effusion, and postoperative drainage. The procedure involves local anesthesia, making a small incision, and inserting the tube through the intercostal muscles into the pleural cavity. The tube is then secured and attached to a drainage system below chest level. Chest tube placement and removal requires careful technique and management to drain the pleural space and prevent complications.

1. -CHEST DRAINS
tube thoracostomy
-Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical Care/ER

2. -INTRODUCTION
-A CHEST TUBE
--Chest drain
--Thoracic catheter
--Tube thoracostomy
--Intercostal Drain
--It is a flexible plastic tube that is
inserted through the chest wall
between the two layers of the
pleura.
-- The other end of the tube is attached
to a drainage device placed below
chest level, allowing the air or fluid
to drain from the pleural space

3. -NEEDLES FOR PUTTING
CHEST DRAIN

4. -PROCEDURE OF PUTTING
CHEST DRAIN

5. -INDICATIONS OF
CHEST DRAIN
-PNEUMOTHORAX
-When there is Air or Gas in the pleural space.
--In any ventilated patient
--Tension pneumothorax after initial
needle relief
--Persistent or recurrent pneumothorax
after simple aspiration
--Large simple spontaneous
pneumothorax in patients over 50
years age

6. -PNEUMOTHORAX

7. -OPEN PNEUMOTHORAX

8. -PLEURAL EFFUSION
CHYLOTHORAX
--Lymphatic fluid in the pleural space
EMPYEMA
--Pyogenic infection of pleural space
HEMOTHORAX
--Accumulation blood in the pleural space
HYDROTHORAX
--Accumulation of serous fluid in the pleural
space
POST OPERATIVE
--For Example
a-Thoracotomy
b-Esophagectomy
c-Cardiac surgery

9. TECHNIQUE OF
TUBE THORACOSTOMY

10. -EQUIPMENT FOR THORACOSTOMY
-All the equipment required to insert
a chest tube should be available
--Sterile gloves and gown
--Skin antiseptic solution e.g Iodine
--Sterile drapes
--Gauze swabs
--A selection of syringes and needles
(21 – 25 gauge)
--Local Anesthetic e.g Lignocaine 1%
--Scalpel and Blade
--Suture (e.g “1” silk)
--Instrument for blunt dissection

11. - EQUIPMENT FOR THORACOSTOMY

12. -INSERTION TECHNIQUE
--British Thoracic Society recommends the tube is inserted in an
area described as the “Safe Zone” a region bordered by: the
lateral border of Pectoralis Major and the Anterior border of
Latissimus dorsi and a Horizontal line superior to the Nipple.
More specially the tube is inserted Into the
5th intercostal space slightly anterior to the mid axillary line

13. -INSERTION TECHNIQUE

14. --1-Inject a local Anesthetic solution into the location of the
target 4rth or 5th intercostal space
--2-On an obese patient it can be difficult to palpate the ribs.
However the 4rth or 5th rib will be approximately at a level
just above the nipple.
--3-Make a small incision through the skin
--4-Using Hemostats (Forceps) in a spreading motion to part the
skin and subcutaneous tissue widening the opening.
-INSERTION TECHNIQUE

15. -INSERTION TECHNIQUE --5-Force your finger into the opening and spread subcutaneous
tissue sufficiently to feel the ribs
--6-Using hemostats, push the closed end through the intercostal
muscles and spread the Hemostats forcefully and open to form
a hole in the intercostal muscles
--7-Push your finger back into the space, and twisting your finger
press any tissue back from the Hole
--8-Grasp the chest tube end with forceps and feed it into the
opening.
--9- Tube insertion should be made just above and parallel
to a Rib

16. -INSERTION TECHNIQUE
--10-After insertion, the tube is typically secured by
a suture and the entry area covered by dressings
“Purse string” sutures must not be used.
In the case of Acute Hemothorax, however large
bore tubes (28 – 30 F Minimum) continue to be
recommended for their dual role of Drainage of
the thoracic cavity and assesment of continuing
blood loss

17. -INSERTION TECHNIQUE
--11-The chest tube is then attached to a
drainage system which only allows one
direction of flow
-The respiratory swing in the fluid in the
chest tube is useful for assessing tube
patency and confirms the position of
the tube in the pleural cavity
-Once tube is in place, a x ray is performed
to verify the location of the drain.

18. -INSERTION TECHNIQUE

19. - MANAGEMENT
OF DRAINAGE SYSTEM
-CLAMPING OF DRAIN
--A bubbling chest tube should never be
clamped.
--Drainage of a large pleural effusion should
be controlled to prevent the potential
complications of re expansion
pulmonary edema.
--***In case of Pneumothorax, clamping of
the chest tube should usually be
avoided.

20. -REMOVAL OF CHEST TUBE
--The timing of removal is dependent on the
original reason for insertion and patients
clinical progress
--In case of Pneumothorax, the chest tube
should not be clamped at the time of its
removal there is no evidence that clamping
a chest drain at the time of its removal is
beneficial
--The chest tube should be removed during
expiration with a brisk firm movement
while an assistant ties the previously placed
closure suture