Indications
- Diagnostic: effusion/blood/pus/lymph
- Therapeutic: drainage of air/fluid (effusion, blood, pus, lymph)
Sizes
- French gauge (20-32F) = external circumference in millimetres
- 32F used to prevent clot obstruction of tube
Technique
- Adequately prepared / consented
- Clinical examination + inspection of CXR: confirm side of insertion
- Position: (1) supine + arm abducted (2) seated leaning forwards + arms outstretched
- Skin cleaned w iodine + draped
- 5th ICS / 3rd ICS (Anterior) anterior to MAL by palpation of ribs
- LA wheal w 1-2% lignocaine + deep infiltration
- Insert over rib (avoids neurovascular bundle)
- 1.5-2cm incision w scalpel (11 blade)
- Blunt dissection down to pleura using finger + Roberts forceps finger sweep to clear adhesions + widen tract
- Drain guided into intercostal space
- Aim apically for air / basally for fluid
- Secure with drain stitch + apply dressing/tape
- Attach to underwater seal +/- suction
- Drain bottle below level of patient at all times
- Minimise resistance: chest tube should be sufficiently wide
- End of drainage tube should not be > 5cm below level of water otherwise resistance encountered will prevent air from escaping chest tube
- Check CXR: accurate position + re-expansion
- Analgesia
Complications
- Laceration/puncture intrathoracic/abdominal organs (prevented by finger sweep)
- Infection
- Damage to intercostal nerve/artery/vein
- Subcutaneous emphysema
Indications for removal
- Full lung expansion
- Drain no longer functioning (air/fluid ceased to drain)
- No longer swinging (can flush drain - remove obstruction with normal saline)
Procedure in removal
X-ray after
- Off suction
- With tube clamped
Remove drain in inspiration