Chest tube insertion

Question 1

Chest tube indications

Answer 1

pneumothorax
hemothorax
esophageal rupture
malignant pleural effusion
recurrent pleural effusions
empyema
chlyothorax
postoperative care

Question 2

chest tube contraindications

Answer 2

When the lung is completely adherent to the chest wall

risk of bleeding

Question 3

The size of the chest tube that is needed depends on

Answer 3

the indication for the insertion of a chest tube

Question 4

chest tube complications

Answer 4

bleeding
hemothorax (intercostal artery perforation)
visceral organ damage (lung, heart, diaphragm, intraabdominal organs)
perforation of major vascular structures (aorta, subclavian vessels)
intercostal neuralgia
subQ emphysema
re expansion pulmonary edema
infection
pneumonia
empyema

Question 5

timing of chest tube removal for a pneumothorax

Answer 5

bubbling must have ceased and the lung must be fully expanded on chest radiograph
trial of water seal to ensure that the lung stays expanded without suction

Question 6

timing of chest tube removal for pleural fluid drainage

Answer 6

once the drainage volume is less than 200 ml in 24 hour period
the fluid is serous
the lung is re-expanded on chest film

Question 7

technique for chest tube removal

Answer 7

end-inspiration or end-expiration for the spontaneously breathing patient
fully mechanically ventilated patient-end expiration

Question 8

Chest tube location

Answer 8

4-5 intercostal space in the anterior axillary line at the horizontal level of the nipple

Question 9

What size CT would you use in the selding method

Answer 9

14 french or smaller

Question 10

What size CT would you use for an empyema

Answer 10

20 french or larger

Question 11

Where would you aim the CT to evacuate a pneumothorax? hemorthorax

Answer 11

Aim the tube apically for a pneumothorax and basally for a hemothorax

Question 12

What gauge needle should you use for a needle decompression

Answer 12

14-16 gauge needle