CHEST TUBE INSERTION

CHEST TUBE INSERTION

Preparation :

• Suturing set
• Local anaesthetic +/- sedation
• Chest tube, appropriate size
• Underwater seal with sterile water
• Suction pump

Indications :

1. Pneumothorax with respiratory distress
2. Significant pleural effusion
3. Empyema

Complications :

1. Bleeding
2. Nerve injury
3. Injury to the nearby structures e.g. lung, heart, large vessels, liver
4. Subcutaneous emphysema
5. Infection

Procedure :

In open method, after making the skin incision, continue to dissect the tissues till the pleura is seen.

1. Sedate the child.
2. Position the child with ipsilateral arm fully abducted.
3. Clean and drape the skin.
4. Infiltrate LA into the skin at 4th ICS, AAL or mid axillary line.
5. Make a small incision just above the rib down to the subcutaneous tissue.
6. Place the tip of the chest tube at the incision, point the tip anteriorly for drainage of air and posteriorly for drainage of empyema. Slowly advance the chest tube with introducer by exerting a firm continuous pressure until a ‘give’ is felt.
7. Remove the introducer and advance the chest tube till the desired length.
8. Connect the chest tube to underwater seal. The water should bubble (for pneumothorax) and fluid move with respiration if the chest tube is in the pleural space.
9. Secure the chest tube with pulse string sutures.
10. Connect the underwater seal to suction pump if necessary.
11. Confirm the position with CXR

Size of chest tube mm :

8 for <2kg
10 for >2kg
Older children : 12-18 depending on size