|Technique The tube thoracostomy shall be performed using strict aseptic technique: povidone iodine skin prep, sterile drapes, sterile gloves, gown and mask. Prep the skin widely: from the sternum medially to the bed surface laterally, and from the axilla superiorly to the costal margin inferiorly. Anesthesia should be provided using local infiltration of 1% lidocaine + epinephrine solution. When possible, a small dose of intravenous midazolam (1 - 2 mg) for sedation is appropriate in the non head-injured patient. The minimum acceptable tube size in the adult is 36 French, so as to minimize tube occlusion with clotted blood and thus ensure adequate pleural fluid/blood evacuation.|
The rigid chest tube is mated to the flexible rubber Creech tubing with an intervening ridged plastic connector flange (x). To avoid disconnection and air leaks, the system is secured with narrow strips of cloth tape in the manner shown. By not completely wrapping the joint with tape, any obstructing clot within the narrow diameter connector flange can be noted and quickly cleared.
(Ancef) 1 gram iv should be given within 30 minutes prior to tube
insertion, and the same dose repeated once in eight hours. Prolonged
antibiotic coverage has not been shown to minimize the incidence of
infectious complications in the trauma population requiring emergency tube
all chest tubes will be placed to 20 (twenty) cm water suction via the thoracic
drain apparatus. The water level in the suction chamber must be monitored
daily and kept at the appropriate by level by adding sterile water to
counteract the normal evaporative losses that will diminish the effective
force of the chest tube.
the chest tube reservoir apparatus from wall suction constitutes placement
of the patient on water seal. This will be done prior to chest
tube removal, assuming the three conditions listed below have been met.
Generally, a chest x-ray will be taken to document continued lung
expansion after placement on water seal and before actual removal of the
tube from the chest.
In the adult,
a chest tube is considered ready for removal only after all
of the following
conditions have been met:
1. Luchette FA, Barie PS, Oswaski MF, et.al: Prophylactic Antibiotics in Tube Thoracostomy for Traumatic Hemopneumothorax. Eastern Association for the Surgery of Trauma - Practice Guidelines 2000. Click here to see the EAST guidelines.
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