Chest Tube, NICU

A chest tube is a small tube that is put into the chest between the ribs. The chest tube is put into the space between the lungs and the chest wall (pleural space). Air or fluid can collect in this space. When air or fluid collects in this space in newborns (neonates), they develop breathing difficulty. When air quickly accumulates in the pleural space, the condition is called a pneumothorax, which can require emergency placement of a chest tube. The chest tube is put into the pleural space to help the neonate breathe normally. The tube drains the excess fluid or air. The tube is kept in until all the fluid or air is drained out. In the neonatal intensive care unit (NICU), neonates are carefully monitored for breathing difficulty. An adhesive tape or stitch is used to keep the tube in place.

The procedure to insert the chest tube is carried out by skilled personnel as an emergency. Usually, the place where the tube is inserted heals well. A small scar may be seen. Your baby may need the chest tube:

  • For breathing problems.

  • For any chest injury or infection.

  • After surgery on the heart or lungs.

RISKS AND COMPLICATIONS

Risks and complications of the procedure include:

  • Incorrect placement of the chest tube.

  • Bleeding caused by injury to blood vessels.

  • Infection, if the tube is kept for a long period.

  • Injury to your baby's lungs.

BEFORE THE PROCEDURE

The area where the chest tube will be inserted will be numbed with a local anesthetic. Your baby may be sedated and placed in a lying position. A towel or blanket may be used to support his or her back.

AFTER THE PROCEDURE

An X-ray exam of the chest is done to check the position of the tube. When the air or fluid is no longer draining, your baby's caregiver will clamp the chest tube for 2 to 4 hours to check if there is an air or fluid leak before removing the tube. The caregiver will repeat the X-ray exam to check if the lungs are working properly. Your baby will be given antibiotics to prevent infection.

HOME CARE INSTRUCTIONS

Your baby's caregiver will place a dressing over the site where the tube is inserted. You should:

  • Retain the dressing for at least 2 days and keep the area clean.

  • Avoid getting the area wet.

  • Follow the caregiver's advice regarding your baby's diet and activity.

SEEK MEDICAL CARE IF:

  • Your baby is not breathing normally.

  • Your baby is grunting every time it breathes.

  • You notice sucking of the skin between the baby's ribs when the baby breathes.

  • You notice your baby's nostrils are opening wide when they breathe.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your baby is restless.

  • Your baby is crying continuously.

  • Your baby is irritable.

  • Your baby is breathing fast.

  • Your baby has episodes of apnea (no breathing for more than 20 seconds).