What is a tube thoracostomy?
In a tube thoracostomy (chest drainage), pleural fluid, air, blood, and pus are removed from the pleural cavity.
A tube thoracostomy, also known as open chest drainage, is a surgical procedure to drain the collection of pleural fluid, air, blood, or pus from your pleural cavity through a tube inserted in your chest.
The pleural cavity is the space lying between the pleura (visceral and parietal)—the two thin layers that surround the lungs. This space contains a small amount of liquid known as the pleural fluid, which acts as a lubricant for the expansion and contraction of the lungs during respiration.
When there is an excessive collection of the pleural fluid or buildup of air, blood, or pus in your pleural cavity, you will have difficulty in breathing. In such conditions, a tube thoracostomy eases your breathing.
In some situations, such as severe traumatic injuries to the chest, a tube thoracostomy becomes an emergency and a life-saving procedure.
When do you need a tube thoracostomy?
You need a tube thoracostomy if you suffer from the following conditions:
- Pleural effusion: An excessive collection of the pleural fluid in the pleural cavity.
- Pneumothorax: A leakage of air in the pleural activity.
- Hemothorax: A collection of the blood in the pleural cavity.
- Hemopneumothorax: A collection of the blood and air in the pleural cavity.
- Hydrothorax: A collection of the fluid in the pleural cavity due to organ (the liver or heart) failure.
- Chylothorax: A collection of chyle (lymphatic fluid) in the pleural cavity.
- Empyema: A collection of pus in the pleural cavity.
What is done before a tube thoracostomy?
- Your doctor will physically examine you and ask for your signs and symptoms. They will order an X-ray and a computed tomography (CT scan) of your chest to decide the best approach for performing a tube thoracostomy.
- You and your family will be explained about the procedure and its complications, and your written consent will be taken for the same.
How is a tube thoracostomy performed?
- Your doctor will tell you to lie down on your back, or sit and lean forward.
- They will mark the skin below your axilla with a pen and then clean it with an antiseptic solution.
- They will inject an anesthetic solution locally to numb the marked area. This will make the procedure less painful for you.
- They may also give you a painkiller and a sedative.
- They will first insert a needle attached to a syringe in the marked area to aspirate the fluid and confirm the location of tube insertion.
- They will make an incision of around 1.5-2 cm in the marked area.
- They will insert a chest or drainage tube measuring between 6 and 14 mm through the incision.
- They will stop the procedure if you experience chest tightness or start coughing at this time.
- The chest tube may have valves around its insertion, and it is connected directly to the outside collection chamber, which collects drainage from the chest cavity.
- The remaining part of the incision wound and chest tube are covered with bandages and sticking to secure the tube in place.
What is done after a tube thoracostomy?
- Your doctor will order a chest X-ray to confirm the correct placement of the chest tube.
- They will monitor you by closing and opening the valve of the chest tube to allow the flow and stop the drainage as needed.
- After adequate drainage, they will remove your chest tube and close the wound with sutures and bandages.
- They will perform a chest X-ray to confirm the resolution of your original disease. Another chest X-ray taken several hours after the removal of the chest tube will show if a complication such as pneumothorax has developed.
What are the complications of a tube thoracostomy?
Minor complications of thoracostomy tube placement such as pneumothorax or misplacement of the tube are common. Other possible complications are as follows:
- Bleeding: Bleeding may be at the incision wound, inside the chest, or in the abdomen (organ penetration).
- Tube dislodgement: If the tube gets dislodged, it is replaced by another tube.
- Hemothorax: The tube is reinserted after the hemothorax resolves.
- Empyema: Empyema may occur due to the entry of bacteria through the chest tube.
- Pulmonary edema (fluid collection in the lungs): A rare and life-threatening condition that is more common in patients with diabetes and those with large pleural effusion.
What is the difference between thoracotomy and thoracostomy?
A thoracotomy is an operation in which the chest wall is opened to gain access to any of your chest organs, to obtain the tissue samples for laboratory examination or to remove a part of your lung or your entire lung. Being a major surgery, surgeons use it as a last resort when all other options of diagnosis or treating a particular lung disease have failed.
A thoracostomy involves the insertion of a surgical tube into the pleural space to drain air or fluid from the chest through a small incision. It is a simpler procedure than thoracotomy.