Chest Drain Insertion - Indications, Contraindications, Procedures, and Complications

Introduction:

A chest tube is a delicate tube made of plastic that a surgeon will place into the pleural area, which is the space between the chest wall and the lungs. Surgeons may mandate using a chest tube for multiple purposes, involving inflating a collapsed lung, exhausting fluid or blood, or producing medications. The flexible chest tube near the lung is positioned between the ribs and in the area between the internal lining and the innermost lining of the chest cavity. It is known as the pleural space. This procedure is performed to enable the lungs to expand completely. In addition, it is utilized to empty pneumothoraces or outflows from the intrathoracic area. All intercostal drains placed for pleural effusions should be accurate-time and ultrasound-guided.

What Are the Indications of Chest Drain Insertion?

The indications of chest drain insertion involve-

• Hemothorax is an indication of chest tube drain insertion.

• In the cases of primary pneumothorax, which is not resolved, their measurement is more than two centimeters after two trials of aspiration.

• Chest drain insertion is done in secondary pneumothorax, whose measurement is higher than two centimeters.

• Unilateral pleural effusion causes breathlessness. In this condition, they place a drain to reduce the manifestation and help diagnose.

• Empyema- in the case of empyema, chest drain insertion is a condition in which there is a collection of pus in the pleural space.

• Bilateral pleural effusions- in these cases, if decompensation is done despite optimal medical management.

• In cases of occurrence of tension pneumothorax, which is the build-up of air in the lungs after needle decompression

• Palliation of breathlessness in pleural effusions malignancy.

• To promote pleurodesis.

• It is indicated in cases of collapsed lungs.

• Lung infections caused by bacterial pneumonia are also complicated by pus accumulation.

• Pneumothorax is the air near or beyond the lung.

• Bleeding, hemorrhage around the lung, particularly after a trauma like a car accident.

• Fluid accumulation occurs because of any other medical situation involving cancer or pneumonia.

• Difficulty in breathing because of the formation of fluid or air.

• These include lung surgeries, heart surgeries, or esophageal surgeries.

What Are the Contraindications of Chest Drain Insertion?

The contraindications of chest drain insertion involve coagulopathy, hemothorax, and infection that occurs locally at that site.

How Is Chest Drain Insertion Done?

• Chest tube insertion is typically performed as an emergency pre- or postoperatively. If this procedure is not done as an emergency, a chest X-ray is taken to locate the site of the symptom causing the build-up of air or fluids. In addition, specific tests to assess the pleural fluid, like a chest ultrasound or chest CT (computed tomography) scan, are also executed.

• A surgeon or a pulmonary specialist does this method. It begins by preparing a considerable extent on the part of the chest, from the armpit inferior to the abdomen and across the nipple. This includes sterilizing the space. This is followed by injecting an anesthetic agent into the skin or the vein to anesthetize the chest tube's site. These anesthetic agents support being comfortable during a procedure; otherwise, it would be unbearable. Finally, in case of significant heart or lung surgery, the patient will be given general anesthesia.

• In most cases, an incision is made between the ribs and the top part of the chest. Then the surgeon will slowly open the space in the chest cavity and direct the tube into the chest. Chest tubes are available in different dimensions. Next, the surgeon will suture the chest tube in a position to control it. A sterile bandage is kept on the insertion site.

• For drainage, a tube is then connected to a particular one-way drainage system that permits the flowing of the air or fluid out. This controls the backflow of fluid or air into the chest cavity.

• The chest tube is positioned. Thus the patient should remain in the hospital. A doctor will observe breathing and review for any air leaks if present.

• The duration of placement on the chest tube depends on the disease that generated the formation of air or fluid. For example, certain lung cancers can cause fluid to collect, so the surgeon will place the tube in for a more prolonged period in some instances of malignancy.

• Before inserting the chest tube into the chest, the other end of the line is placed or connected to a drainage system. This system comprises a bottle to gather the air or fluid and a leakage fence water stamp or seal.

• The leakage barricade water seal is constructed when the bottle is loaded with a saline solution. Followed by one end of the tube is placed into two centimeters of that saline solution, and the additional end is placed into the pleural hole.

• This causes decompression of the chest pressure or produces negative pressure and withdraws the fluid or air as the pressure surrounding the lungs is more down than the atmospheric pressure outside the body.

What Are the Complications of Chest Drain Insertion?

• Discomfort and ache during insertion, chest tube insertion are typically extremely painful. Therefore, the surgeon will control the pain by giving an anesthetic agent via an intravenous route or into the chest tube area. In some instances, general anesthesia is given, which causes the patient to sleep, or local anesthesia, which anesthetizes that location.

• Infection, as with any intrusive process, is a risk of infection with this procedure. The use of sterile instruments during the operation decreases this complication.

• Bleeding or hemorrhage can occur in small quantities if a blood vessel is injured while placing the chest tube.

• Poor tube placement means, in certain cases, the chest tube can be inserted too distant inside or not adequately inside the pleural space. As a result, there is a chance of falling out of the tube in certain cases.

Conclusion:

A chest tube can be a typically non-invasive method to reach the pleural space, deplete fluid build-up, and administer medication. Occasionally, if the chest tube does not cure a patient's problem, they may require a more invasive surgical procedure. After chest tube disposal, the patient should follow the doctor's guidance on taking care of the incision location.