Chest Tube

 

Used to create negative pressure in the chest cavity and allow re-expansion of the lung

 

Modalities

• Suction

  • actively suctions air and fluid from chest cavity

    • pleurodesis/decortication: 24-72 hrs to optimize visceral/parietal pleura 

    • diaphragm surgery: helps decrease fluid accumulation

    • subcutaneous emphysema

    • difficult dissection or bleeding concern

    • pneumothorax >1cm

• Water seal

  • allows air and fluid to escape the chest cavity by gravity

    • esophageal surgery: placed near anastomosis in case of leak

• Clamp

  • simulates the chest tube being removed to assess for silent airleaks

  • silent airleaks: causes increasing pneumothorax or subcutaneous emphysema

 

Pleurovac

• First Chamber - Collection Chamber

  • blood/fluid collects by gravity and air continues onto 2nd chamber

• Second Chamber - Waterseal chamber

  • acts as a one way valve to allow air to escape but not to re-enter the chest cavity

  • tidaling: seen in this chamber

    • tells you the system is connected to the chest and patent (occurs secondary to begative pressure in the chest) - NORMAL

    • changes with inspiration and expiration

  • bubbling in this chamber indicates an air leak

• Third Chamber - Suction control

  • controls the amount of suction based on the height of the water

  • gentle bubbling is normal

 

Air Leaks

• most common complication after lung resection

• leakage of air across the alveolar surface of the visceral pleural (alveolar-visceral pleura)

• examine the entire tubing system and wound for any loose connections or slip in the tube

• "jacuzzi water" with bubbles

  • continuous

  • intermittent

  • with cough

• Risk Factors

  • steroids

  • emphysematous lungs

  • re-operation with extensive scar tissue

 

Treatment

• 80-120cc blood patch into the chest tube self-sealing tubing

  • reposition the patient every 20 minutes for 1 hour

• surgicel / gelfoam

  • wedged into the airway(s) with leak

  • self dissolving in weeks

• bronchial blocker (need a pediatric scope)

• endobronchial valve

  • permits air passage during expiration but not during inspiration

• Heimlich Valve: one way valve that allows home discharge; must tolerate waterseal

• re-do surgery

  • locate airleaks and remove that portion of lung tissue

  • biologic glue placed

 

Chest Tube Removal

• no airleak present

• serosanginous output (no signs of bleeding present)

• after epicardial wires have been removed

• output < 150-400cc over 24 hours

• off ventilator positive pressure