Chest tube thoracostomy involves inserting a plastic tube between the ribs and into the chest cavity to drain fluid, blood, or air that has accumulated in the pleural space around the lungs. This procedure is used to treat conditions such as pneumonia, cancer, chest injuries, or a collapsed lung. A small incision is made between the ribs and a tube is inserted before being connected to suction. The tube remains in place until drainage stops, usually a few days.

1. THORACOSTOMY TUBE INSERTION
Description:
Chest tube thoracostomy is done to drain fluid, blood, or air from the space around the lungs.
Some diseases, such as pneumonia and cancer, can cause an excess amount of fluid or blood to build up
in the space around the lungs (called a pleural effusion). Also, some severe injuries of the chest wall can
cause bleeding around the lungs. Sometimes, the lung can be accidentally punctured allowing air to
gather outside the lung, causing its collapse (called a pneumothorax). Chest tube thoracostomy
(commonly referred to as "putting in a chest tube") involves placing a hollow plastic tube between the
ribs and into the chest to drain fluid or air from around the lungs. The tube is often hooked up to a
suction machine to help with drainage. The tube remains in the chest until all or most of the air or fluid
has drained out, usually a few days. Occasionally special medicines are given through a chest tube.
Purpose:
Chest tube insertion is basically for the purpose of draining fluid, blood or air form the lung cavity to
regain negative pressure.
Indications:
1. Drainage of hemothorax, or large pleural effusion of any cause
2. Drainage of large pneumothorax (greater than 25%)
3. Prophylactic placement of chest tubes in a patient with suspected chest trauma before
transport to specialized trauma center
4. Flail chest segment requiring ventilator support, severe pulmonary contusion with effusion
Contraindications:
1. Infection over insertion site
2. Uncontrolled bleeding diathesis
Equipments:
 Tube thoracostomy tray  Large straight suture scissors
 Sterile gloves  Silk or nylon suture, 0 or 1-0
 Sterile drapes  Vaseline gauze
 Surgical marker  Gauze squares, 4x4 in (10)
 Lidocaine 1% with epinephrine  Sterile adhesive tapes, 4 in wide
 Syringes, 10-20 mL (2)  Chest tube of appropriate size
 Needle, 25 gauge, 5/8 in Man-28-32F
 Needle, 23 gauge, 1.5 in or 27 gauge, Woman-28F
1.5 in for instilling local anesthesia Child-12-18F
 Blade no 10’11 blade, on a handle Infant-12-16F
 Large and medium Kelly clamps Neonate-10-12F
 Large curved mayo scissors
Procedure:
YES NO
A. PREPARATORY PHASE
1 Informed consent
2 Chest x-ray result

2. 3 Wash hands
4. Assemble the drainage system/other equipment needed
5. Reassure the patient and reinforce the steps of the procedure. Inform the
patient to expect a needle prick and a sensation of a slight pressure during
infiltration of anesthesia
6. Position the patient
7. Clearly mark the site of the chest tube insertion
8. Shave excessive hair and apply a preparatory solution to a wide area of the
chest wall
B. SKIN PREPARATION AND MARKING
9. Wear sterile gloves, gown, hair cover, and goggles or face shield, and apply
sterile drapes to the area
10. Identify the fifth intercostals and the midaxillary line
11. The skin incision is made between the midaxillary and anterior axillary
lines over a rib that is below the intercostal level selected for chest tube
insertion
12. A surgical marker can be used to better delineate the anatomy
13. Administer a systemic analgesic (unless contraindicated)
14. Use the 25 ga. Needle to inject 5 mL of the local anesthetic solution into
the skin overlying the initial skin incision
15. Use the longer needle 923 or, preferably, 27 ga) to infiltrate about 5 mL of
the anesthetic solution to a wide area of subcutaneous tissue superior to
the expected natal incision
16. Use the number 11 or 10 blade to make a skin incision approximately 4cms
long overlying the rib that is below the desired intercostals level of entry.
17. A curve haemostat is inserted into the pleural cavity and the tissue is
spread with a clamp
18. A tract is explored with an examining finger
19. The tube is held by the haemostat and directed through the opening up
over the ribs and into the pleural cavity
20. The clamp is withdrawn and the chest tube is connected to a chest
drainage system
21. A 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin
22. Apply petroleum (eg Vaseline) gauze over the skin incision
23. Create an occlusive dressing to place over the chest tube by turning
regular gauze squares (4x4 in) into Y-shaped fenestrated gauze square and
using 4 in. Adhesive tape to secure them to the chest wall
24. Strap the emerging chest tube on to the lower trunk with a adhesive tape,
as this avoids kinking of the tube as it passes through the chest wall
C. Follow-up phase
25. Observe the drainage system for blood or air. Observe for fluctuation in
the tube on respiration
26. Secure a follow-up x-ray
27. Assess for bleeding, infection, leakage of air and fluid around the table
Diagram/ Images: