A chest tube, also known as a thoracic catheter or chest drain, is a flexible plastic tube inserted through the chest wall. Its primary purpose is to drain accumulated air, fluid, or blood from the pleural space, the area between the lungs and the inner chest wall. This intervention helps restore normal lung function and alleviate respiratory distress.
Why a Chest Tube is Needed
A chest tube is necessary when air, fluid, or blood collects in the pleural space, disrupting the negative pressure that facilitates lung expansion.
Common conditions requiring a chest tube include:
Pneumothorax: Air leaks into the pleural space, often called a collapsed lung, compressing it and making breathing difficult.
Hemothorax: Blood accumulates in the chest cavity, typically due to injury.
Pleural effusion: Excess fluid builds up, stemming from conditions like heart failure, infections, or tumors.
Empyema: Pus is present in the pleural space, requiring drainage to clear the infection.
Chest tubes are also placed after thoracic surgeries to manage expected postoperative fluid or air drainage and prevent complications. Removing these substances is important for lung re-expansion.
How Chest Tubes Function
A chest tube system drains air or fluid from the pleural space while preventing outside air from re-entering. The tube connects to a drainage system, which typically consists of multiple chambers. One chamber collects the drained fluid for measurement and monitoring.
A key component is the water seal chamber, which contains sterile water and acts as a one-way valve. This water seal permits air and fluid to exit the chest cavity during exhalation but prevents atmospheric air from being drawn back into the pleural space during inhalation. Some systems also incorporate a suction control chamber, which can apply gentle suction to facilitate drainage when gravity alone is insufficient.
The Insertion Process
Chest tube insertion is a medical procedure performed by trained healthcare professionals. Before the procedure, the patient is positioned to provide access to the chest wall. The insertion site is cleaned with an antiseptic solution and numbed with a local anesthetic to minimize discomfort.
A small incision is made through the skin between the ribs. Tissue layers are separated until the pleural space is reached. The chest tube is then guided through this opening and positioned within the pleural space, with its tip directed appropriately depending on whether air or fluid is being drained. Once placed, the tube is secured to the skin with sutures to prevent dislodgement and covered with a sterile dressing.
Living with a Chest Tube
Patients with a chest tube require careful monitoring. Discomfort or pain around the insertion site is common, as the tube can cause a tugging sensation. Pain management is an important aspect of care, often involving oral or intravenous pain medications.
The drainage system is continuously monitored for the volume, color, and consistency of the fluid being removed. Healthcare providers also observe for bubbling in the water seal, which indicates an air leak from the lung. Patients are advised to keep the drainage system below the level of their chest to ensure proper gravity drainage and prevent backflow. Any changes in breathing, increased pain, or signs of infection, such as redness or swelling, should be reported to medical staff.
Potential Issues and Removal
Potential complications of chest tube placement include infection at the insertion site, bleeding, or accidental dislodgement. Persistent air leaks, where air continues to escape from the lung, may also occur. Medical staff continuously monitor for these issues.
The chest tube is removed once the underlying condition has resolved and specific criteria are met, such as minimal drainage volume and the absence of an air leak. Imaging, such as a chest X-ray, is performed to confirm lung re-expansion before removal.
The removal process is performed by a healthcare professional, often after administering pain medication. The sutures holding the tube are removed, and the tube is gently pulled out. An occlusive dressing is then applied, and wound care instructions are provided.