Chest Tube Insertion
Chest tube insertion helps drain air, blood, or infection from the pleural space (the space surrounding your lungs).
During a chest tube insertion, a specially designed tube is inserted through the side of your body, between the ribs, and into the pleural space.
A chest tube insertion is typically an emergency procedure or may occur after surgery involving the chest or organs in the chest cavity.
Chest tube insertion is also referred to as chest tube thoracostomy.
Why Do You Need Chest Tube Insertion?
You may need a chest tube if you experience any of the following:
- collapsed lung
- lung infection
- bleeding around your lung, especially after a trauma such as a car accident
- fluid buildup due to another medical condition, such as cancer or pneumonia
- inability to breathe, or breathing discomfort because of fluid or air buildup
- surgery, especially lung, heart, or esophageal surgery
Inserting a chest tube may also help your doctor diagnose other conditions, such as internal injuries after a trauma or lung damage, especially if there is a persistent air leak.
Getting Ready for Chest Tube Insertion
Because chest tube insertion is most commonly performed as an emergency procedure or after surgery, there is minimal preparation required by the patient. If you are conscious, your doctor will ask for your consent to perform the procedure. If you are unconscious, he or she will explain why a chest tube was necessary after you wake.
Commonly, an X-ray, chest ultrasound, or chest CT (computed tomography) scan are performed prior to chest tube insertion to help confirm if fluid or air buildup is the cause of your lung problem and to determine if a chest tube will help.
What Happens During Chest Tube Insertion?
A surgeon or a pulmonary or critical care specialist usually performs a chest tube insertion.
- Your doctor will prep a large area on the side of your chest, from your armpit down to your abdomen and across to your nipple. This will involve sterilizing the area using Betadine and potentially shaving any hair from the site, if necessary.
- An intravenous (IV) and/or local anesthetic may be used to make you more comfortable during the chest tube insertion, which can be painful.
- Using a scalpel, he or she will then make a small (¼ inch to 1½ inch) incision between the ribs near the upper part of your chest (the specific location will depend on the reason for the chest tube).
- Your doctor will gently open a space into your chest cavity using a finger and clamps, and guide in the chest tube. (Chest tubes come in various sizes for different conditions.)
- A small suture keeps the tube in place, and a sterile bandage is applied. The tube is then attached to a special one-way drainage system that only allows air or fluid to flow out. This prevents drainage back into the lung.
While the chest tube is in, a doctor or nurse will continually monitor your breathing, pain, and chest tube status.
What Risks Are Involved?
Pain During Placement
Some patients have reported pain of nine or 10 on a one-to-10 scale while the chest tube is being inserted. [Laws, 2003] Your doctor will help manage your pain with an intravenous (IV) anesthetic and/or a local anesthetic injected into the chest tube site.
As with any invasive procedure, there is a risk of infection. Using sterile procedures helps reduce this risk.
A very small amount of bleeding can occur if a blood vessel is damaged when the chest tube is inserted.
Poor Tube Placement
The chest tube can be placed too far inside the pleural space, not far enough, or can fall out.
Serious complications are rare, occurring on average in fewer than five percent of cases. However, they can include:
- bleeding into the pleural space
- injury to the lung, diaphragm, or stomach
- collapsed lung during tube removal
Removing the Chest Tube
The chest tube usually stays in for a few days. After your doctor is sure that no more fluid or air needs to be drained, he or she will remove the chest tube.
Removing the chest tube is usually performed quickly, and without sedation. Your doctor will give you specific instructions; however, it is important to remove the chest tube as you are holding your breath in or out to ensure no extra air gets into your lungs.
Afterward, a bandage will cover the insertion site. You may have a small scar.
Your doctor may schedule an X-ray at a later date to ensure that air or fluid buildup hasn’t recurred.