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Chest Tube Thoracostomy How I Do It / How I Did It?

 Benjamin C. Deveza

Level I Resident

OMMC Surgery

 

Chest Tube Thoracostomy

Indications

            To evacuate air, fluid, blood or pus from the pleural cavity

 Usual Operative Technique

                        Under local anesthesia

 

How I do it / How I did it?

 Pre-operative evaluation : History taking

                                             Physical Examination auscultation of the chest to

                                                                                 determine correct laterality

                                              Chest x-ray - establishes the presence of air, fluid or

                                                                        blood in the pleural cavity

-  determine the correct laterality

 Operative technique

Patient on sitting position

Disinfection of operative site with povidone-iodine

Infiltration of local anesthesia over the appropriate intercostal space                  

Transverse incision over the skin and subcutaneous tissue

Blunt dissection with a hemostat done until the intercostal space is  

                      reached

Finger inserted to dilate the tract sufficiently

Chest tube Fr 36 inserted

Intraop findings noted

Tube anchored to the skin with silk 0

Chest tube connected to a underwater sealed drainage                                                                                                                                                              

Hemostasis

Dry sterile dressing applied

Postoperative Care

            Repeat chest x-ray to determine the level of chest tube inserted

             and if there is complete or partial evacuation of air, fluid or blood

            Encourage deep breathing exercises

            Wound care

            Thora bottle care

            Follow-up for removal of chest tube

 

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