Thoracostomy Tubes

Question 1

What is a thoracostomy tube used for?

Answer 1

Treatment of pleural space disease and for continued post-op drainage
-pneumothorax, pyothorax, hemothorax

Question 2

What size tubes should be used for suppurative effusion vs. air?

Answer 2

Effusion should have larger tube

Air should have smaller tube

Question 3

What should the width of tube be similar in size to?

Answer 3

Less than or equal to the width of the intercostal space

Question 4

What is the start and end point for a thoracostomy tube?

Answer 4

Start: dorsal 1/3rd of thoracic wall at 7-9 intercostal space
End point: elbow

Question 5

Where is the skin incision made for a thoracostomy tube insertion?

Answer 5

2-3 rib spaces caudal to desired intercostal entry point

Question 6

How is a thoracostomy tube secured?

Answer 6

Purse string and finger trap suture pattern w/ non-absorbable suture

Question 7

What is the alternate technique for thoracostomy tube placement?

Answer 7

assistant displaces skin cranially –> incision AND tube entry occurs at desired intercostal space
- allows direct entry inot correct space w/out tunneling, dissection through fat and muscle and more controlled entry into thoracic cavity

Question 8

What confirms correct placement and advancement?

Answer 8

Rads

Question 9

If redirection is required what should be re-inserted?

Answer 9

Sterile trochar

Question 10

What structures are used to ensure system is closed?

Answer 10

C-clamp
Christmas tree adapter
3-way stopcock
Wire/nylon suture

Question 11

When can the thoracostomy tube be removed when dealing with air vs. fluid?

Answer 11

Air: absence of pneumothorax for 12-24 hrs
Fluid: production of less than 2 mLs/kg/day