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What is a chest tube?

 A chest tube is a common therapeutic procedure, often performed by Interventional Radiology. The purpose of a chest tube is to evacuate an abnormal collection of air or fluid from the pleural space. The pleural space is located in between the lungs and the chest wall (outside of the lung) The procedure is also used for diagnostic purposes if a sample of collected fluid is sent for analysis to determine the cause of the fluid accumulation.

What is a chest tube for?

Common conditions that require chest tube placement are:

  • Pneumothorax – an abnormal collection of air in the pleural space causing collapse of the lung

  • Hemothorax- an abnormal collection of blood in the pleural space, that decreases oxygenation

  • Empyema –a collection of pus (infected fluid) between the 2 layers of tissue that line the lungs

  • Drainage of recurrent pleural effusion –excess fluid that builds around the lung

What happens if a chest tube is placed?

The overall goal of chest-tube therapy is to promote lung re-expansion, restore adequate oxygenation and prevent complications. After the chest tube is placed it will be connected to suction tubing or to a Heimlich valve. A Heimlich valve is attached to the end of the chest tube and prevents fluid or air from going back into your chest. You can walk around more freely and go home with a chest tube and Heimlich valve. If your chest tube is connected to suction tubing you will have to stay at the hospital. The tubing will connect to a drainage system that will be monitored by the nursing staff. Most effusions are treated this way and when the drainage from the tube is less than 150ml per 24 hours (usually 3-4 days after insertion) the chest tube can be removed. Chest x-rays will be taken as needed, to help monitor your lungs progress while the chest tube is in place. This will help evacuate the pleural space of air or fluid and allow the lung to return to normal. The chest tube insertion site will be covered with a gauze dressing that serves as protection to your skin from bacteria and also helps keep the tube from accidentally being pulled out. If the tube is accidentally removed you should place an occlusive dressing over the site and tell your nurse or call your doctor.

How is a chest tube placed?

The procedure is performed at El Camino Hospital in the radiology department. An entire team will be taking care of you during the procedure including a radiology nurse, a radiology technologist and the physician. In the Interventional Radiology procedure room, the nurse will help you lay on an exam table. You will be connected to heart, blood pressure and oxygen monitors.  Medicine may be given to relax you through your IV called moderate, also known as “twilight,” sedation. Your procedure area will be prepped and sterilized.  A numbing medicine will be injected into the area (local anesthetic). Using imaging guidance, the pleural space will be visualized a small puncture will be made through the skin, between the ribs and into the pleural space.  A guidewire will then replace the needle and a small catheter (tube) will replace the guide wire.  The tube exiting your skin will be temporarily sutured and/or tapped in place and then will be connected to a drainage container.  Sometimes the tube will be connected to continuous suction.  

The procedure time usually takes about 15-20 minutes. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.

How long does the chest tube need to stay?

It really depends on the purpose. For air (pneumothorax) – until the air leak stops, which usually takes 1-3 days. For fluid (pleural effusion) – usually we wait until the fluid drainage is less than 200mL/24hour. But it can vary from case to case.

What are the risks?

Having a chest tube placed is a relatively low risk procedure, but with any procedure there is always a small risk of bleeding and infection.  Thankfully these risks are low and with the use of image guidances (CT and/or ultrasound) injury to adjacent structures is also very low.

What can I expect with the chest tube?

If you had respiratory symptoms such as chest pain with breathing, difficulty breathing or shortness of breath, having a chest tube may improve these symptoms almost immediately.  Some patients have some discomfort and pain where the chest tube is placed, which is to be expected, but usually tolerable.  

How is the tube removed?

When the effusion or pneumothorax has resolved and the tube is no longer needed it is easy to remove. The bandage will be removed from your skin and the holding suture will be cut. The tube can easily be removed and gently slides out from the skin. An occlusive dressing is left in place and can be removed 24 hours later. The skin should heal normally with minimal scarring. Watch for any signs of infection such as redness, drainage, swelling, shortness of breath, cough, increased heart rate or difficulty breathing. Should any of these symptoms develop, please call your doctor or go directly to the nearest Emergency room.

What happens if the air leak or fluid does not stop?

In cases of pneumothorax that do not resolve in more than 4-5 days, “clipping” of the leaking hole may be necessary. This is usually done with a minimally invasive surgery, where cameras are introduced in the pleural cavity to guide the small instruments.  This would be done by a cardiothoracic surgeon.

In cases of pleural effusion that continue to have a lot fluid daily fluid drainage, the chest tube may be considered to be changed to a chest tube that you can go home with and drain at home called a tunneled PleurX catheter.  This would be done by your interventional radiologist.  The PleurX catheter can always be removed at any time, usually when fluid stops re-accumulating.  

Is the fluid or air going to accumulate again?

Depending on the cause of the fluid, it may or may not reaccumulate.  You will likely have follow-up imaging to assess in a few weeks to make sure.  Most pneumothoraces are low risk for recurring, but you may also have follow-up imaging and close monitoring of your respiratory symptoms in the following weeks.

What can be done to prevent the fluid / air to re-accumulate ?

The most obvious way to prevent reaccumulation is to treat the underlying cause.   For example, if the fluid is from an infection then antibiotics are usually necessary.  Your fluid is likely going to be tested if there is not a known reason for its cause.

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