1. 흉관 관리 및 배액법

2. Role of chest tube Removal of fluid or air from pleural space
restoration of the negative pressure
full expansion of the lung
effective gas exchange
Instillation of chemotherapeutic agent after removal of malignant effusion

3. Indications of chest tube insertion
post-thoracotomy status
hemothorax
pneumothorax
empyema
chylothorax
emphysema disease
prophylactic: ARDS, high PEEP
others

6. Placement of chest tube
Post-thoracotomy status
usually two site insertion(28Fr, 32Fr)
Pneumothorax
usually 4th ICS on anterior axillary line
흉강경 수술이 예상될 경우 7th ICS on
mid- axillary line
Pleural fluid
usually 5th, 6th ICS on mid axillary line (가능한
dependent position에 위치)
Loculation이 된 경우라면 위치가 달라질 수도 있으며 .
방사선과에서 PCD (Pigtail Chest Drainage) 시행
Chest tube size
Pneumothorax : 20-28Fr,
Effusion : largest that can easily be drained

7. Post-thoracotomy status

8. Chest tube insertion, I

9. Chest tube insertion, II

10. Underwater seal drainage system
A. one-bottle system
B. two-bottle system
C. three-bottle system
D. balanced drainage system
* Heimlich valve
outpatient management

11. Bottle systems

12. Commonly used bottles

13. One bottle
Two bottle

14. Suction To overcome the air leak
To expand the lung early only in air leak
Optimal pressure ~ -20 cm H2O
Higher levels of suction should be avoided
lung damage, pulmonary edema
avoid vigorous milking or squeezing

15. Observation of drainage system
Fluctuations according to respiratory pattern
absent - full expansion
- blocked tubing
Fluids: volume, color, consistency
Hemothorax > ml/hr
Air leak
Tube clamping should be avoided
Bottle position: 70-90cm below the thorax

16. Position & Drain

18. Check point during Chest tube management, I
Clot in chest tube inside patient
clot in the tube
dependent loop in patient tube with fluid
kink in patient tube
partial dislodgment of catheter
partial disconnection between tube and catheter

19. Chest tubes

20. Check point during Chest tube management, I
Clot in chest tube inside patient
clot in the tube
dependent loop in patient tube with fluid
kink in patient tube
partial dislodgment of catheter
partial disconnection between tube and catheter

22. Check point during Chest tube management, I
Clot in chest tube inside patient
clot in the tube
dependent loop in patient tube with fluid
kink in patient tube
partial dislodgment of catheter
partial disconnection between tube and catheter

23. Check point during Chest tube management, II
Overfilled water seal
in line connectors not properly secured
patient tube clamp in situ
chest drain in not upright
insufficient suction
suction is too vigorous
too high chest drain position

24. Check point during Chest tube management, II
Overfilled water seal
in line connectors not properly secured
patient tube clamp in situ
chest drain in not upright
too high chest drain position
insufficient suction
suction is too vigorous

25. Check point during Chest tube management, II
Overfilled water seal
in line connectors not properly secured
patient tube clamp in situ
chest drain in not upright
too high chest drain position
insufficient suction
suction is too vigorous

26. Chest tube occlusion Etiology prevention
blood clots or viscous pleural effusion
kinking of chest tube
prevention
strip chest tube hourly
insert sufficient large tube
insert additional tube to help evacuate blood, if needed
eliminate kinking by proper positioning and exit location of the tube - never place tube posterior to midaxillary line

27. Pneumothrax kit
Trocar
Semirigid catheter
Heimlich valve

28. Urgent transfusion

29. Removal of chest tube Indication Clamp the tube for 12-24hrs
air and fluid are no longer present in the pleural space
full re-expansion of the lung
Clamp the tube for 12-24hrs
“Inflate and hold ” technique
Occlusive dressing
Be confirmed by chest X-ray

30. Reminder again Water seal Keep the bottle below the patient
Transporting injured patient with Chest bottle; do not clamp the tube
Right connection between bottle and chest tube
Periodic check kinking of the tube
Avoid back pressure to chest tube drainage

31. Comment
Very useful and effective measure to evacuate intrathoracic air and/or fluid
Should be carefully observed because the chest tube and bottle system is not always safe