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