Chest Drainage
Insertion of a tube into the pleural space helps treat pneumothorax, hemothorax, empyema, pleural effusion, and chylothorax. It’s also routinely inserted at the completion of a thoracotomy. The tube allows drainage of blood, fluid, pus, or air from the pleural space. In pneumothorax, it restores negative pressure to the pleural space by means of an underwater seal drainage system. The water in the system prevents air from being sucked back into the pleural space during inspiration. (If the leak is through the bronchi and can’t be sealed, suction applied to the underwater-seal system removes air from the pleural space faster than it can collect.) As negative pleural pressure is restored, the lung can reinflate.
Procedure
Position the patient on his unaffected side. After the physician injects the local anesthetic at the insertion site, help the
patient hold still while the physician makes a small incision and tunnels the tube through the tissue into the pleural space. Usually, the physician places the tube anteriorly near the second or third intercostal space if he wants to remove air; laterally and slightly posteriorly at about the eighth intercostal space if he wants to remove fluid. He may place tubes at both locations if he wishes to remove both air and fluid.
patient hold still while the physician makes a small incision and tunnels the tube through the tissue into the pleural space. Usually, the physician places the tube anteriorly near the second or third intercostal space if he wants to remove air; laterally and slightly posteriorly at about the eighth intercostal space if he wants to remove fluid. He may place tubes at both locations if he wishes to remove both air and fluid.
Life-threatening complicationsCombating tension pneumothorax
Tension pneumothorax is a life-threatening complication that may be fatal if not treated promptly. It occurs when air becomes entrapped within the pleural space due to dislodgment or obstruction of the chest tube. Increasing positive pressure within the patient’s chest cavity compresses the affected lung and the mediastinum, shifting them toward the opposite lung. The result is markedly impaired venous return and cardiac output, leading to cardiac arrest.
Signs and symptoms
Suspect tension pneumothorax if the patient exhibits cyanosis, air hunger, agitation, hypotension, tachycardia, and profuse diaphoresis.
As part of your assessment, palpate the patient’s face, neck, and chest wall for subcutaneous emphysema. Also check to see if the patient’s trachea has deviated from its normal midline position; this is a telltale sign of tension pneumothorax. Auscultate his lungs for decreased or absent breath sounds on the affected side, and percuss the chest for hyperresonance.
Emergency interventions
If you suspect a tension penumothorax, take these steps:
Notify the patient’s physician immediately.
Be prepared to assist with reinsertion of the chest tube or insertion of a large-bore needle to relieve air pressure in the thorax.
Inspect the chest drainage unit for kinks in the tubing. Correct any mechanical problems immediately.
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