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Neuro Critical Care
13 Chest Tube Insertion
Built from Jallo — Neurocritical Care Procedure Atlas
What’s inside
13 sections · 60 slides
Overview
- What this deck will teach you
What a Chest Tube Is - and Why
Draining air or fluid so the lung can re-expand
- Start with the basic picture
- Why the space filling up is a problem
- Where and when it is done
Relevant Anatomy and Physiology
The pleural space, its lining, and how fluid comes and goes
- The pleural space and its lining
- How the space is normally kept dry
- Pleural fluid turnover - a balanced trickle
Indications - When To Place One
Emergency reasons first, then the nonemergent ones
- Emergency indication - pneumothorax
- Emergency - hemothorax and esophageal rupture
- Nonemergent indications
- The indications at a glance
Contraindications
No absolute barriers, only cautions
- There is no absolute contraindication
- Other cautionary situations
Equipment
The kit, the materials, and choosing the right tube size
- The chest tube kit
- Prepackaged chest tube insertion kit
- Instruments, sutures, and drainage
- Chest tube size and technique by indication
- Reading the size table
Technique - Preparation
Positioning, finding the safe entry zone, and anesthesia
- Positioning the patient
- The triangle of safety - where to enter
- Triangle of safety for chest tube entry
- Marking, sterility, and draping
- Anesthetizing the track down to the pleura
- One more prep step in penetrating trauma
Technique - Seldinger
Guiding a small tube in over a wire
- The Seldinger idea - a wire leads the way
- Seldinger technique for chest tube insertion
- Dilating, placing the tube, and securing it
- Connecting and confirming
Technique - Standard (Open)
Making a track by hand for larger tubes
- The standard technique - opening the track by feel
- Standard open chest tube technique
- Entering the pleura and the finger sweep
- Placing and directing the tube
- Securing, connecting, and confirming
Removal
Deciding the tube has done its job, and taking it out safely
- When to remove - pleural effusion
- When to remove - pneumothorax
- Removal technique - the mechanically ventilated patient
- Removal technique - the spontaneously breathing patient
Complications
What can go wrong and how to recognize it
- The common complications
- Infection and the role of prophylactic antibiotics
- A couple of numbers worth remembering
- Re-expansion pulmonary edema - rare but dangerous
Expert Tips and Troubleshooting
Bedside tips to keep it working
- Watching tubes and troubleshooting a lost air leak
- Further clearing steps and difficult placements
Wrap-Up
The essentials in one pass
- Rapid review: why a chest tube, and how do you place one safely?
- Conclusion - the take-home message
- References
- Neuro ICU Procedure Atlas