Chest tube insertion and removal
Description
Pleural space containing a thin layer of lubricating fluid that allows the visceral and parietal pleura to move without friction during respiration
Excess fluid (hemothorax or pleural effusion), air (pneumothorax), or both in the pleural space changing intrapleural pressure and causing partial or complete lung collapse
Allows drainage of air or fluid from the pleural space
Usually performed by a physician with nurse assistance, and requires sterile technique
Insertion sites varying; dependent on the child’s condition and the physician’s judgment
After insertion, chest tubes connected to a thoracic drainage system that removes air and fluid from the pleural space, prevents backflow, and promotes lung reexpansion
Equipment
Two pairs of sterile gloves ♦ sterile drape ♦ povidone-iodine solution ♦ vial of 1% lidocaine ♦ 10-ml syringe ♦alcohol pad ♦ 22G 1″ needle ♦ 25G 3/8″ needle ♦ sterile scalpel (usually with #11 blade) ♦ sterile forceps ♦ two rubber-tipped clamps for each chest tube ♦ sterile 4″× 4″ gauze pads ♦ two sterile 4″ × 4″ drain dressings (gauze pads with slit) ♦ 3″ or 4″ sturdy, elastic tape ♦ 1″ adhesive tape for connections ♦ chest tube of appropriate size (#16 to #20 French catheter for air or serous fluid; #28 to #40 French catheter for blood, pus, or thick fluid), with or without a trocar ♦ sterile Kelly clamp ♦ suture material (usually 2-0 silk with cutting needle) ♦ thoracic drainage system sterile drainage tubing, 6′ (1.8 m) long, and connector ♦ sterile Y-connector (for two chest tubes on the same side) ♦ petroleum gauze
Essential steps
Explain the procedure to the child and his parents, provide privacy, and wash your hands.
Record baseline vital signs and respiratory assessment.
If the child has pneumothorax, position him in high Fowler’s, semi-Fowler’s, or the supine position. The physician will insert the tube into the anterior chest at the midclavicular line in the second or third intercostal space.
If the child has hemothorax, have him lean over the overbed table or straddle a chair with his arms dangling over the back. The physician will insert the tube into the fourth, fifth, or sixth intercostal space at the midaxillary line.
For either pneumothorax or hemothorax, the child may lie on the unaffected side with arms extended over his head.
When you’ve positioned the patient properly, place the chest tube tray on the overbed table.
Open the equipment using sterile technique.
The physician will prepare the insertion site by cleaning the area with povidone-iodine solution.
Wipe the rubber stopper of the lidocaine vial with an alcohol pad.
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