"Chest Tube Placement" by Chris Weldon for OPENPediatrics

Summary

Dr. Christopher Weldon, a surgeon at Children's Hospital Boston, demonstrates the process of placing a chest tube, or thoracostomy tube. The video covers patient preparation, the step-by-step procedure of inserting the chest tube, connecting it to a suction device, and addressing potential complications. Key points include ensuring patient safety, proper use of equipment, and documenting the procedure. The video emphasizes the importance of anatomical landmarks and careful technique to avoid complications, making it a comprehensive guide for medical professionals.

Takeaways

• 🔹 Dr. Christopher Weldon, a surgeon and intensivist at Children's Hospital Boston, provides a demonstration on thoracostomy tube placement, commonly known as chest tube placement.
• 🔹 The demonstration covers preparation, placement, and connection to a suction device to remove air and fluid from the chest.
• 🔹 Indications for the procedure include compression of the lung and mediastinal structures due to the accumulation of air, fluid, or blood in the pleural space.
• 🔹 There are no true contraindications, but caution is advised for patients with skin infections, coagulopathy, or adhesions in the chest area.
• 🔹 Necessary equipment includes a surgical chest tube, antimicrobial scrub, scalpel, forceps, clamps, sutures, needle driver, suction source, collection device, and monitoring equipment.
• 🔹 Preparation involves scrubbing hands, using universal precautions, confirming procedure details with the team, and prepping the chest with antimicrobial agents before draping with sterile towels.
• 🔹 Placement requires identifying anatomical landmarks such as the nipple and anterior axillary line, making an incision, bluntly dissecting into the pleural space, and securing the tube with sutures.
• 🔹 The chest tube is connected to a collection device to manage air and fluid drainage, ensuring no leakage and proper negative pressure.
• 🔹 The chest tube can be removed when there is no further leakage of fluid or air, confirmed by chest x-ray, and no reaccumulation is observed.
• 🔹 Complications may include injury to organs, bleeding, pneumothorax, infection, and it's essential to monitor the patient's vital signs, oxygen saturation, and comfort level throughout the procedure.

Q & A

What is the main purpose of a chest tube (thoracostomy tube)?

The main purpose of a chest tube is to remove air, fluid, or blood from the pleural space to relieve compression of the lung and mediastinal structures.

What are the indications for performing a chest tube placement?

Indications for chest tube placement include the accumulation of air, fluid, or blood in the pleural space causing compression of the lung and mediastinal structures.

Are there any contraindications to chest tube placement?

There are no true contraindications to chest tube placement, but caution should be exercised in patients with skin infections over the insertion site, coagulopathy, a platelet count less than 50,000 per microliter, pulmonary bullae, pleural adhesions, or diaphragmatic adhesions.

What equipment is needed for chest tube placement?

The equipment needed includes a surgical chest tube, antimicrobial scrub, scalpel, forceps, Kelly clamp, sutures, needle driver, suction source, chest tube collection device, male-to-male connector, shoulder roll, and monitoring equipment.

What are the steps involved in preparing a patient for chest tube placement?

Preparation steps include scrubbing hands with an antimicrobial agent, using universal precautions, confirming the procedure and side with the surgical team, performing a surgical time-out, applying antimicrobial prep to the chest, ensuring the patient is anesthetized and properly prepped, and draping the field with sterile towels.

What is the key anatomical landmark for chest tube placement?

The key anatomical landmark for chest tube placement is the nipple, which signifies roughly the fourth intercostal space, where the chest tube is placed in the anterior axillary line just lateral to the nipple.

How is the chest tube secured after placement?

The chest tube is secured in place with sutures, often using a single Roman stitch technique to tie it down to the skin and around the tube. An occlusive dressing is then placed over the insertion site.

What is the procedure for connecting the chest tube to the collection device?

A male-to-male connector is used to connect the chest tube output to the collection device. The connection is ensured to be secure with no evidence of leakage of air or fluid around the tube.

When can a chest tube be removed?

A chest tube can be removed when there is no further leakage of fluid or air into the pleural space, confirmed by a chest x-ray and absence of reaccumulation of air or fluid in the collection device.

What complications can arise from chest tube placement?

Possible complications include injury to the lungs, heart, liver, other organs, and soft tissues, bleeding, pneumothorax, and infection.

What should be documented after chest tube placement?

Documentation should include the indication for the procedure, date and time, size and site of chest tube placement, amount and type of drainage removed, confirmation of placement on chest x-ray, and any adverse outcomes.