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Chest tube insertion lab

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Presentation on theme: "Chest tube insertion lab"— Presentation transcript:

1 Chest tube insertion lab

2 Tube placement sites Depends on purpose Anterior (triangle of safety)
Pneumothorax Low lateral (Ultrasound guidance really helps) Fluid drainiage

3 Indications

4 Triangle of Safety

5 Incision and Insertion Sites

6 Dissection OVER rib

7 Chest tube size Air: small Fluid: medium Blood: Large Pus: Large

8 Alternate procedures Underwater seal jar Heimlich valve
Simple needle aspiration and recheck For simple pneumothorax only: Small No tension Underwater seal jar Heimlich valve

9 Tube removal criteria Pneumothorax: no bubbling and lung expanded
Consider an interval of tube clamping before removal Probably best to not remove while on mechanical ventilation, especially with PEEP Drainage: less than 200 cc/24 hours Take care to seal hole during and after removal! Follow-up chest x-ray

10 Complications Bleeding and hemothorax due to intercostal artery perforation Perforation of visceral organs (lung, heart, diaphragm, or intra-abdominal organs) Perforation of major vascular structures such as the aorta or subclavian vessels Intercostal neuralgia due to trauma of neurovascular bundles, Subcutaneous emphysema, Re-expansion pulmonary edema Infection of the drainage site Pneumonia, and empyema Technical problems such as intermittent tube blockage from clotted blood, pus, or debris, or incorrect positioning of the tube, which causes ineffective drainage.

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