Chest Tube Insertion

Question 1

What is the risk of draining a large pleural effusion too quickly?

Answer 1

Reexpansion pulmonary edema

Question 2

To minimize the risk of reexpansion pulmonary edema, do not allow drainage to exceed more than

Answer 2

1 - 1.5 L of fluid in a half hour

Question 3

What are the possible complications of chest tube insertion?

Answer 3

Bleeding and hemothorax d/t intercostal artery perforation
Organ perforation
Intercostal neuralgia
Tube blockage
Subcutaneous emphysema
Reexpansion pulmonary edema
Local infection and empyema

Question 4

How little should the chest tube be draining before considering removal of the tube?

Question 5

There are no absolute contraindications for chest tube insertion except when…

Answer 5

…a lung is completely adherent to the chest wall through the hemithorax.

Question 6

What size scalpel should you have in a chest tube tray?

Answer 6

Size 11

Question 7

What size sutures are appropriate for securing a chest tube?

Answer 7

Size 1.0 or larger

Question 8

What size chest tube is appropriate for a patient with a large pneumothorax in stable condition?

Answer 8

16-French to 22-French

Question 9

What size chest tube is appropriate for a patient with a large pneumothorax in UNSTABLE condition, a patient receiving mechanical ventilation, or a secondary pneumothorax?

Answer 9

24-French to 28-French

Question 10

What size chest tube is appropriate for a patient with a malignant pleural effusion or transudative effusion?

Answer 10

A smaller bore (8-French to 16-French) should be tried first, if ineffective a larger-bore, 22-French or higher, should be used.

Question 11

What size chest tube is appropriate for a patient with a parapneumonic effusion or empyema?

Answer 11

No firm recommendations, but a 20-French or larger should be tried.

Question 12

The Seldinger method is performed with the use of __-French or smaller chest drains.

Answer 12

14

Question 13

Maximally ______ the ___________ arm or place it behind the patient’s head.

Answer 13

abduct

ipsilateral

Question 14

Using 1% or 2% lidocaine solution and a __-gauge needle, create a _____ of anesthetic in the cutaneous tissue at the marked spot.

Answer 14

25-gauge

wheal

Question 15

__ to __ ml of lidocaine should be used to ensure _______ _________.

Answer 15

10 to 20 ml

optimal analgesia

Question 16

How long should your initial incision be?

Answer 16

1.5 to 2 cm

Question 17

Use your finger to palpate within the pleural layer and ensure that…

If it does not, this may indicate the presence of…

Answer 17

…the lung falls away from the pleura.

…an adhesion.

Question 18

Do not reclamp the chest tube, once released, unless…

Answer 18

…the pleural drainage system is being changed.

Question 19

Reclamping the tube may lead to…

Answer 19

…the redevelopment of a pneumothorax and may create a tension pneumothorax.

Question 20

If suction is being used, most providers will use a trial of…

Answer 20

…underwater seal to ensure that the lung stays expanded without suction.

Question 21

Extreme caution should be used when removing a chest tube…

Answer 21

…from any patient on mechanical ventilation.