Procedure - Chest Tube

Question 1

What is the sizing system for French catheters?

Answer 1

They get bigger as they get bigger.

To get the cross-sectional diameter of the catheter, divide the number by three and you get it in mm.

For instance, a 32F is 10.4 mm.

Question 2

What spot do you insert chest tubes in?

Answer 2

Mid axillary line, nipple line, just above the rib

Question 3

How wide of a transverse cut do you make?

Answer 3

Two finger widths

Question 4

Aim the chest tube toward ___________.

Answer 4

The apex

Question 5

What size chest tube is the go to tube in adults?

Answer 5

28 French

Question 6

The most common brand of chest tube box is ____________.

Answer 6

Pleur-Evac

Question 7

What suction should you set a chest tube to?

Answer 7

-20 to the box

You can also control suction at the box.

Question 8

Review the steps of chest tube insertion.

Answer 8

• Use the larger Kelley clamps to grasp the insertion side of the tube and another Kelley to close the distal end so that fluid/blood doesn’t rush out
• Feel for the 5th or 6th intercostal space in the midaxillary line (roughly in the same plane as the nipple)
• Cover with betadine
• Anesthetize with lidocaine (if the patient is stable enough)
• Make an incision just superior to the 6th or 7th rib parallel to the rib
• Use the small Kelley clamp to blunt dissect through the intercostal muscles and parietal pleura
• Open the clamp and then use your left index finger to hold the path open
• Guide the tube in with your Kelley clamps
• Insert until the last hole on the tube is in the pleura

Question 9

What area should you prep and drape?

Answer 9

From clavicle to costal margin and from sternum to posterior axillary line

Question 10

How far should you insert the chest tube?

Answer 10

Until the last hole is in the pleural space

Question 11

How should you secure a chest tube?

Answer 11

• Use a 0 silk suture to make an interrupted suture across the cut you made in to introduce the tube. Tie it in the middle of the suture with long threads on either side.
• Wrap one of the threads around the tube, pull it tight, and tie it to the other thread.
• Cover the base of the tube with cut gauze that straddles the tube.
• Tape over the tube with wide tape.
• Use a narrow strand of tape to pinch the tube and anchor it.

Question 12

The most popular brand of chest tube suction box is called _________.

Answer 12

Atrium

You’ll sometimes hear someone say “have you set up the Atrium yet”?

Question 13

A “pigtail” is what size catheter?

Answer 13

20 Fr

Question 14

What size chest tube is needed for a hemothorax?

Answer 14

32 - 40 Fr

Question 15

In what directions should you guide a chest tube for a hemothorax and a pneumothorax?

Answer 15

Hemothorax: posterior

Pneumothorax: apex

Question 16

What is the recommended chest tube site in third-trimester pregnancy?

Answer 16

3rd intercostal space (compared to the usual 4th-5th)