What is a Chest Tube Used For? A chest tube is a medical device used to remove air, fluid, or pus from the pleural space—the area between the lung and chest wall. It is often inserted in emergency or post-surgical situations to relieve pressure on the lungs and prevent collapse. Chest tubes are commonly used to treat conditions such as pneumothorax (collapsed lung), pleural effusion (fluid accumulation), or hemothorax (blood in the pleural space), helping to restore normal breathing function.

What Are 5 Indications for a Chest Tube?

There are several situations in which a chest tube may be required. Here are 5 chest tube indications:

1. Pneumothorax: This is one of the most common reasons for a chest tube, where air accumulates in the pleural cavity, leading to a collapsed lung. A chest tube for pneumothorax helps evacuate the air and re-expand the lung.
2. Hemothorax: The accumulation of blood in the pleural space, often due to trauma or surgery, may necessitate the use of a chest tube to drain the blood and restore normal lung function.
3. Pleural Effusion: When fluid (such as pus, serous fluid, or blood) collects in the pleural space, a chest tube can be used to drain it, alleviating pressure on the lung and improving respiratory function.
4. Post-surgical drainage: After thoracic surgery, chest tubes are commonly used to drain any residual air or fluid and prevent complications such as infection or re-expansion pulmonary edema.
5. Chylothorax: This is a rare condition where lymphatic fluid accumulates in the pleural space, usually due to injury or disease of the thoracic duct. A chest tube helps to drain the fluid and relieve symptoms.

How Many Types of Chest Tubes Are There?

There are several types of chest tube drainage systems designed to suit different clinical needs. The main categories include:

1. Simple Chest Tube: A straight or slightly curved tube used for basic drainage of air or fluid.
2. Suction Chest Tube: This type of chest tube is connected to a suction device to provide continuous or intermittent suction, often required when more effective drainage is necessary.
3. Chest Tube for Drainage with an Air Leak: These tubes are designed with additional components to monitor and manage air leaks, particularly useful in cases of pneumothorax or post-surgical recovery.
4. Multi-chamber Chest Tube System: A more complex system, often used in cases requiring careful monitoring of drainage volumes and pressure, especially in critical care or trauma settings.

What is ICD and Chest Tube?

ICD stands for Insertable Chest Drain or Intercostal Chest Drain. This term refers to a type of chest tube insertion that involves placing a drainage tube between the ribs (intercostal space) to allow the removal of air, fluid, or blood. ICDs are typically used in the management of conditions like pneumothorax, hemothorax, and pleural effusion. They are designed for both short-term and long-term drainage and can be part of the broader chest tube procedure.

What Size is a Chest Drain?

Chest tube size can vary depending on the condition being treated and the patient’s anatomy. Chest tubes are measured in French units (Fr), where the diameter is proportional to the size. Common chest tube sizes range from:

• 12 Fr to 24 Fr for pneumothorax or drainage of small amounts of air or fluid.
• 28 Fr to 40 Fr for hemothorax or larger pleural effusions, as these tubes are better suited to drain thicker fluids or greater volumes.

In general, a smaller chest tube size may be used for air drainage, while a larger size is needed for blood or viscous fluid.

How to Insert a Chest Tube?

Chest tube insertion is a surgical procedure that is typically performed under local anesthesia with sedation or, in some cases, general anesthesia. Here’s an overview of the chest tube procedure:

1. Preparation: The patient is positioned, usually in a semi-reclined or supine position. The chest area is cleaned and sterilized.
2. Anesthesia: Local anesthetic is injected to numb the insertion site. In some cases, sedation or general anesthesia may be used.
3. Incision: A small incision is made between the ribs, typically in the 5th or 6th intercostal space (mid-axillary line).
4. Insertion: The chest tube is carefully advanced into the pleural space, either by using blunt dissection or with the aid of a guidewire.
5. Positioning and Securing: Once the chest tube is in place, it is connected to a chest tube drainage system to facilitate continuous drainage. The tube is secured with sutures and a sterile dressing.
6. Post-Insertion Care: The patient is monitored for any complications, and imaging may be performed to confirm the correct placement of the chest tube.

What Are the Parts of Chest Tubes?

A chest tube consists of several components that work together to ensure effective drainage and monitoring:

1. Chest Tube: The flexible tube itself, often made from silicone or rubber, is designed to be inserted into the pleural cavity. It comes in various chest tube sizes to suit different needs.
2. Connector: The chest tube has a connector at the proximal end that attaches to the chest tube drainage system.
3. Water Seal Chamber: This is a key part of most drainage systems, preventing air from re-entering the pleural space while allowing air to escape.
4. Suction Chamber: Some chest tube drainage systems include a suction chamber to help facilitate the removal of air or fluid from the pleural space through the application of negative pressure.
5. Collection Chamber: This part of the drainage system collects the air, fluid, or blood drained from the pleural cavity.
6. Clamp: A clamp may be used during the insertion or after placement to control the flow or ensure no air leaks.

Signs and Symptoms of Chest Tube Complications

While chest tubes are life-saving devices, they can lead to complications. Signs and symptoms of chest tube complications may include:

• Infection: Redness, swelling, or discharge at the insertion site.
• Air leaks: Persistent bubbling in the water seal chamber or air sounds may indicate a leak in the system or around the tube.
• Blockage: A sudden cessation of drainage or difficulty flushing the chest tube may suggest a blockage.
• Accidental removal: If the chest tube is dislodged or comes out, it can lead to a reaccumulation of air or fluid, potentially leading to a pneumothorax.

If any of these complications arise, it is critical to seek immediate medical attention.

Conclusion

A chest tube is a vital tool in managing several conditions that affect the pleural space, such as pneumothorax, pleural effusion, or hemothorax. Understanding the chest tube procedure, the types of chest tube drainage systems, and the size of chest drains is essential for both patients and healthcare providers. Prompt and proper chest tube insertion can significantly improve patient outcomes, but awareness of potential complications, such as signs and symptoms of chest tube complications, is equally important for effective management.