Tube Thoracostomy (Training Physician)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Pneumothorax spontaneous (closed) pneumothorax
  • Traumatic open pneumothorax
  • Tension pneumothorax
  • Hemothorax
  • Empyema/Effusions
  • Chylothorax
CONTRAINDICATIONS
  • For unstable injured patients with a pneumothorax or hemothorax, no absolute contraindications to a tube thoracostomy are known.
  • In the stable patient, relative contraindications include multiple pleural adhesions, emphysematous blebs, or scarring.
  • Consider clotting factor replacement for coagulopathic patients before inserting a chest tube.
EQUIPMENT
  • Sterile drapes
  • 10- to 20-mL syringe and assorted needles
  • No. 10 scalpel
  • Forceps
  • Large, straight and curved scissors
  • Large clamps (Kelly) (2)
  • Needle holder
  • No. 1 or 1-0 silk on large cutting needles
  • Gauze pads
  • Local anesthetic
  • Antiseptic solution
  • Adhesive tape—cloth backed
  • Clear, sterile plastic tubing in 6-foot lengths, ½-inch diameter
  • Hard plastic serrated connectors
  • Drainage apparatus with sterile water for water seal
  • Y connectors
  • Chest tubes
  • Drainage and suction systems
ANATOMY
  • Chest wall
    • Each rib is associated with a neurovascular bundle. The bundle lies just inferior to the rib and is composed of an intercostal artery and vein and the intercostal nerve.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Further evaluation of spontaneous pneumothorax
    • The underlying lung pathology of a patient with a spontaneous pneumothorax is best evaluated by CT scan. Often the scan is followed by diagnostic or therapeutic visual inspection of the lung and pleural space by thoracoscopy.
  • Hemothorax
    • Monitor the amount and speed of blood output, which determine the need for additional interventions, including a thoracotomy.
  • Empyema
    • Immediate intervention is indicated because the fluid can become loculated within hours. The tube is left in place until the volume of the pleural drainage becomes clear yellow and the output volume falls to <150 mL per 24 hours.
  • Pain management
    • Local anesthetic may be administered through the chest tube. Use parenteral analgesic agents as needed to control the pain.
  • Prophylactic antibiotics
    • The use of prophylactic antibiotics for patients with a chest tube placed in the ED is controversial.
COMPLICATIONS
  • The most common complications of chest tube insertion include infection, laceration of an intercostal vessel, laceration of the lung, and intra-abdominal or solid organ placement of the chest tube. Local infection at the insertion site is common and is related to the emergency nature of the procedure.
  • Subcutaneous air leak
  • Hemorrhage
  • Failure to correct the pneumothorax
  • Pulmonary edema
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