Download - Chest Tube Insertion
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Chest Tube Insertion
Tim Brandys MD FRCSC
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Indications:
• Pneumothorax(Simple,open,tension)
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Pneumothorax:
• 10% lung volume loss=1 cm Pneumothorax at lateral edge 5th rib upright CXR
• 2CM=20%• 3CM=30%
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Indications:
Evacuate Fluid• Hemothorax• Effusion(benign,malig
nant)• Empyema
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Indications:
Therapeutic:• Pleurodesis• Intrapleural Chemo.
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Indications:
Suspected lung injury
Patient to go for:• General Anes.• Transport• Positive Press.
Ventilation
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Site Selection:• Pneumothorax:
Mid.clav.line 2nd ICS
5th ICS Between Ant. and Mid Ax. Lines
• Pleural Effusion:
5th ICS Post.Axillary Line Loculated Effusion = Determined Radiologically(U/Sor CT)
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Size of Chest Tube:
• Pneumothorax-Small 24 French
• Hemohorax-Large 38 French
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Procedure:
General Tips:
1. Have everything you need at the bedside.
2.Prep and Drape a wide area.
3.Have a plan B.
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Procedure: 1. Consent if appropriate
2. Sedation If approprate
3. Prep and Drape Predetermined spot
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Procedure:
1.Local Anesth.
2.Aspirate with needle to ensure you are in the desired location.
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Procedure:
5. 2-3cm transverse incision over rib.
BLUNT dissection over top of lower rib thru subcut. and muscle with kelly.
6.Puncture Parietal Peritoneum with Kelly
“Pop”
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Procedure:
7. FINGER SWEEP 360
degrees in pleural space
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Procedure:
8. Kelly on chest tube and insert in.
9. Ensure in far enough and,look for “fogging”
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Procedure:
10.Connect to underwater suction,Suture in ,Dressing Chest x-ray
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Complications:1. Laceration intrathoracic or abdominal
organs(Finger Sweep)
2. Empyema
3. Damage Intercostal neurovascular bundle
4. Poor Tube position,Kinking
5. Subcutaneous Emphysema
6. Re-expansion Pulmonary Edema
(> 1 l fluid off)
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Exam Questions:
• Trauma-How much chest tube drainage mandates urgent Thoracotomy?
• How much fluid has to be present to show up on CXR as a pleural effusion ?
• What are the surface landmarks commonly used to count ICS ?