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date: 2021-08-15

chest tube

• related: Pulmonology, Pleural Effusion

Indications

• empyema (pus, loculation), glucose < 40, pH < 7.0 or 0.3 lower than ABG, unimproved effusion after thoracentesis
• 14 French pigtail just as good as surgical CT

Placement

• usually 4th or 5th intercostal space

1. Collection Chamber
   • collects fluid or air
   • air travels to second chamber
2. Water Seal Chamber
   • bubbles = air leak = air coming out of chest still
   • continuous air leak first, then intermittent air leak
   • test air leak with cough: forced exhalation
3. Suction chamber: regulates amount of suction
   • wall suction is very high pressure, -300 cmHg
   • suction chamber has tube that's open to air
   • level of submersion tube is in water determines how much pressure is suctioning

Removing chest tube

• Air: no suction, no bubbles => clamp tube, trial 4 hours or longer
• liquid: < 150cc/24 hours, no clamping needed