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Chest Tube Insertion

Chest Tube Insertion. Tim Brandys MD FRCSC. Indications:. Pneumothorax(Simple,open,tension). Pneumothorax:. 10% lung volume loss=1 cm Pneumothorax at lateral edge 5 th rib upright CXR 2CM=20% 3CM=30%. Indications:. Evacuate Fluid Hemothorax Effusion(benign,malignant) Empyema.

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Chest Tube Insertion

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  1. Chest Tube Insertion Tim Brandys MD FRCSC

  2. Indications: • Pneumothorax(Simple,open,tension)

  3. Pneumothorax: • 10% lung volume loss=1 cm Pneumothorax at lateral edge 5th rib upright CXR • 2CM=20% • 3CM=30%

  4. Indications: Evacuate Fluid • Hemothorax • Effusion(benign,malignant) • Empyema

  5. Indications: Therapeutic: • Pleurodesis • Intrapleural Chemo.

  6. Indications: Suspected lung injury Patient to go for: • General Anes. • Transport • Positive Press. Ventilation

  7. Site Selection: • Pneumothorax: Mid.clav.line 2nd ICS 5th ICS Between Ant. and Mid Ax. Lines • Pleural Effusion: 5th ICS Post.Axillary Line Loculated Effusion = Determined Radiologically(U/Sor CT)

  8. Size of Chest Tube: • Pneumothorax-Small 24 French • Hemohorax-Large 38 French

  9. Procedure: General Tips: 1. Have everything you need at the bedside. 2.Prep and Drape a wide area. 3.Have a plan B.

  10. Procedure: 1. Consent if appropriate 2. Sedation If approprate 3. Prep and Drape Predetermined spot

  11. Procedure: 1.Local Anesth. 2.Aspirate with needle to ensure you are in the desired location.

  12. Procedure: 5. 2-3cm transverse incision over rib. BLUNT dissection over top of lower rib thru subcut. and muscle with kelly. 6.Puncture Parietal Peritoneum with Kelly “Pop”

  13. Procedure: 7. FINGER SWEEP 360 degrees in pleural space

  14. Procedure: 8. Kelly on chest tube and insert in. 9. Ensure in far enough and,look for “fogging”

  15. Procedure: 10.Connect to underwater suction,Suture in ,Dressing Chest x-ray

  16. Complications: 1. Laceration intrathoracic or abdominal organs(Finger Sweep) 2. Empyema 3. Damage Intercostal neurovascular bundle 4. Poor Tube position,Kinking 5. Subcutaneous Emphysema 6. Re-expansion Pulmonary Edema (> 1 l fluid off)

  17. Exam Questions: • Trauma-How much chest tube drainage mandates urgent Thoracotomy? • How much fluid has to be present to show up on CXR as a pleural effusion ? • What are the surface landmarks commonly used to count ICS ?

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