chest tube

Indications

  • empyema (pus, loculation), glucose < 40, pH < 7.0 or 0.3 lower than ABG, unimproved effusion after thoracentesis
  • 14 French pigtail just as good as surgical CT

Placement

  • usually 4th or 5th intercostal space

  1. Collection Chamber
    • collects fluid or air
    • air travels to second chamber
  2. Water Seal Chamber
    • bubbles = air leak = air coming out of chest still
    • continuous air leak first, then intermittent air leak
    • test air leak with cough: forced exhalation
  3. Suction chamber: regulates amount of suction
    • wall suction is very high pressure, -300 cmHg
    • suction chamber has tube that's open to air
    • level of submersion tube is in water determines how much pressure is suctioning

Removing chest tube

  • Air: no suction, no bubbles => clamp tube, trial 4 hours or longer
  • liquid: < 150cc/24 hours, no clamping needed