Name of the Procedure:

Tube Thoracostomy (Commonly known as Chest Tube Insertion) - Open (Separate Procedure)

Summary

A tube thoracostomy, also known as chest tube insertion, is a medical procedure where a tube is inserted through the chest wall and into the pleural space, typically to remove air, fluid, or pus that has accumulated around the lungs. This procedure is often performed in emergency or critical care settings using an open technique.

Purpose

The purpose of a tube thoracostomy is to drain abnormal collections of air, fluid, or pus from the pleural space, which can compromise lung function and pose a serious health risk. The primary goal is to re-expand the lungs and restore normal breathing.

Indications

• Pneumothorax (collapsed lung due to air in the pleural space)
• Hemothorax (blood in the pleural space)
• Pleural effusion (fluid accumulation in the pleural space)
• Empyema (pus in the pleural space)
• Post-surgical drainage
• Traumatic chest injury

Preparation

• The patient may need to fast for several hours prior to the procedure.
• Medication adjustments may be necessary, particularly for blood thinners.
• Pre-procedure imaging such as a chest X-ray or CT scan to locate the fluid or air accumulation.
• Consent form signed after explaining the procedure and its risks.

Procedure Description

1. The patient is positioned, usually lying on their back or side.
2. The skin is cleaned and sterilized, and a local anesthetic is administered to numb the area.
3. A small incision is made in the chest wall.
4. The muscles between the ribs are separated, and the chest tube is carefully inserted into the pleural space.
5. The tube is connected to a drainage system, such as a water seal drainage system, to allow fluid or air to escape.
6. The tube is secured in place with stitches and covered with a sterile dressing.
7. A chest X-ray is performed post-insertion to ensure proper placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Tube thoracostomy is usually performed in hospital settings, including emergency departments, intensive care units, or surgical suites.

Personnel

• Surgeons or emergency physicians
• Nurses
• Anesthesiologists, if general anesthesia is required

Risks and Complications

• Infection at the insertion site
• Bleeding
• Injury to the lungs or other organs
• Persistent air leaks
• Pain
• Re-expansion pulmonary edema

Benefits

• Immediate relief from symptoms caused by the accumulation of air, fluid, or pus.
• Improved breathing and lung function.
• Prevention of further complications, such as lung collapse.

Recovery

• Monitoring in a hospital setting for a few days.
• Pain management with medications.
• Regular chest X-rays to ensure the effectiveness of the drainage.
• Instructions on how to care for the insertion site and the chest tube.
• Follow-up appointments to assess healing and tube removal.

Alternatives

• Needle aspiration for small pneumothorax or effusion.
• Observation, particularly for small and stable pneumothorax.
• Video-Assisted Thoracoscopic Surgery (VATS) for more complex cases.

Patient Experience

• The patient may feel pressure or discomfort during the insertion.
• Pain at the insertion site, manageable with pain relief medication.
• Sensation of improved breathing almost immediately after the procedure.
• Some restrictions on movement while the chest tube is in place to prevent dislodgement.

The procedure is generally well-tolerated, and most patients report significant relief of symptoms shortly after the tube thoracostomy is performed. Pain management and regular monitoring ensure a smoother recovery process.