Chest Tube

A chest tube involves the surgical placement of a hollow, flexible drainage tube into the chest. The purpose of the tube is to drain fluid or blood from the chest cavity or to remove air that has accumulated between the lung and the inside of the chest wall. There are many causes for these problems, but all can interfere with the ability of the lung to be able to expand completely and work efficiently. This can be a dangerous situation, and re-expansion of the lung may be critical.

The tube is inserted and placed between the ribs and into the space between the inner lining of the chest wall and the outer surface of the lung. This space is called the pleural cavity. Depending upon the type of problem being treated, the tube may be inserted through an incision in the front of the chest or off to the side of the chest.

The area where the tube will be inserted is numbed with a local anesthetic. Sometimes, medication for pain and sedation is also given directly into a vein. An incision is made in between the ribs, and a small opening is made through the inner lining of the chest wall. The chest tube is inserted through this opening and is connected to a box-like plastic container that contains sterile water. Suction is attached to the system for drainage. A stitch (suture) and tape keep the tube in place.

In certain people, the chest tube may be inserted using a minimally invasive technique guided by X-ray. Sometimes chest tubes are placed during major lung or heart surgery while the person is under general anesthesia.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medications taken including herbs, eye drops, over-the-counter medications, and creams.

  • Use of steroids (by mouth or creams).

  • Possible pregnancy, if applicable.

  • Previous problems with anesthetics or numbing medication.

  • History of blood clots (thrombophlebitis).

  • History of bleeding or blood problems.

  • Previous surgery.

  • Other health problems, particularly those affecting your lungs and breathing.

RISKS AND COMPLICATIONS

  • Bleeding.

  • Injury to the lung.

  • Malfunction usually due to leaking of air around the tube and inadequate suction.

  • Infection.

  • Allergic and other types of reactions to anesthetics and/or pain medications.

BEFORE THE PROCEDURE

Wash all of the skin in the area of the chest where the tube will be placed. Try to remove any loose, scaling skin. There is no other specific preparation necessary unless advised otherwise by your caregiver.

AFTER THE PROCEDURE

The chest tube usually stays in place until X-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed. Most people do not need medications to sedate or numb them while the chest tube is removed. Antibiotics may be used to prevent or treat infection.

Most people stay in the hospital until the chest tube is removed. While the chest tube is in place, the nursing staff will carefully check for possible air leaks, breathing difficulties, and the need for additional oxygen. You will need to breathe deeply and cough often to help re-expand the lung, assist with drainage, and prevent fluids from collecting in the lungs.

HOME CARE INSTRUCTIONS

Some people will go home with a chest tube in place and a drainage or suction device still attached. In these cases, you should:

  • Keep the drainage device upright. If it falls over, stand it up again. It will continue to drain. The next time you are examined by a visiting nurse, tell him or her that the unit fell over.

  • Keep the drainage device below chest level to help drainage by gravity. Make sure the unit is below chest level when you are sitting, standing, lying down, and walking.

  • Keep 2 clamps nearby. If any tube gets disconnected, clamp the tubing closest to your body with both clamps. Call your caregiver for directions. You may need to go to the Emergency Department if the problem cannot be solved.

  • Check the tubing often to make sure it is not kinked. When the tubing is kinked, draining will not take place properly, and you may have some trouble breathing.

  • You may shower with the chest tube. Cover the area where the chest tube comes out with a small plastic bag and tape it well. Bring the drainage device to the shower area and leave it outside the shower curtain or door. The unit should never be under the direct flow of water.

  • You may want to shower just before the visiting nurse comes. The nurse can then check the site and apply a new dressing. You will have to talk to your visiting nurse to arrange your shower time with your nursing visit.

  • Gentle exercise such as walking is important to help your breathing and circulation. You should talk to your caregiver about any other activity and exercise you want to do.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

IF THE CHEST TUBE FALLS OUT:

  • Do not panic.

  • Open a package of petroleum jelly-coated gauze

  • Open a package of dry, square gauze

  • Cover the wound first with the petroleum jelly gauze and then cover that with the square gauze

  • Tape the dry gauze in place

  • After you have covered the site, call your caregiver for directions. He/she will decide if you need to be seen or go to the nearest Emergency Department.

SEEK MEDICAL CARE IF:

  • Your incision is getting redder, has opened, or has discharge.

  • You have drainage from the incision area.

  • You develop red streaking of the skin that extends above or below the incision.

  • Your drainage changes color or becomes red or bloody.

  • Your pain is not controlled with the medicines prescribed.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have a fever.

  • You develop any new trouble with breathing.

  • You develop any chest pain, lightheadedness, unusual sweating, weakness, or you faint.

  • Your connecting tubes become disconnected.

  • Your chest tube falls out.