Definition
If enough fluid or air accumulates in the pleural space, the negative pressure becomes positive and the lungs collapse. As a result, chest tubes are inserted to drain the pleural space, re-establish negative pressure, and allow for proper lung expansion. Tubes may be inserted in the mediastinal space to drain air and fluid postoperatively.
20 inches long, vary in size from 12-40F. Size is determined by underlying condition.
Large (36-40F)—> blood
Medium (24-36F)—> fluid
Small (12-24F)—> air
Pigtail (10-24F)—> alternative tx for pneumothorax
Insertion
Location: OR, emergency department, bedside
Position: arm above head, elevated 30-60 degrees
Procedure: chest x-ray to confirm affected side. Cleansed with antiseptic, infiltrated with local anesthesia, small incision made over rib. Sutured in place and connected to drainage system. Wound is covered with occlusive dressing (petroleum airtight gauze). Proper placement confirmed with chest x-ray.
***Monitor for pain! It’s painful!
Flutter/Heimlich Valve
One way rubber valve attached to external end of chest tube. Opens with inspiration, closes with expiration.
Can be used for small to moderate size pneumothorax. This allows for patient mobility as it is attached to a drainage bag.
**BAG MUST BE VENTILATED. If it does not come with a vent, a small slit in the bag may be made in order to ventilate it.
Patients may go home with flutter valve system.
Pleural Drainage
