Tube Thoracostomy: Complications and the Role of Prophylactic Antibiotics

Posted by e-Medical PPT Tuesday, October 12, 2010
A chest tube (tube thoracostomy) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. 
 Indications
*Pneumothorax:
*Pleural effusion: Chylothorax, Empyema, Hemothorax, Hydrothorax
Contraindications to chest tube placement include refractory coagulopathy, lack of cooperation by the patient, and diaphragmatic hernia.
Chest tubes are usually inserted under local anesthesia. The skin over the area of insertion is first cleansed with antiseptic solution, such as iodine, before sterile drapes are placed around the area.If necessary, patients may be given additional analgesics for the procedure. Once the tube is in place it is sutured to the skin to prevent it falling out and a dressing applied to the area. Once the drain is in place, a chest radiograph will be taken to check the location of the drain.
Major complications are hemorrhage, infection, and reexpansion pulmonary edema. Chest tube clogging can also be a major complication if it occurs in the setting of bleeding or the production of significant air or fluid.

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1 Response to Tube Thoracostomy: Complications and the Role of Prophylactic Antibiotics

  1. Ed Boyle Says:
  2. Interesting Presentation. I have seen this problem many times in my practice. I find it curious that antibiotics do not stop the problem. Antibiotics cost a lot of money and take nursing time and they dont seem to help. They may even hurt the situation. If one out of 5 chest tubes lead to a serious infection that is a serious problem given the number of chest tubes placed each year. You mention un drained hemothorax as a possible cause. Why does this occur? In my experience it occurs becuase the drainage continues, but the chest tubes clog or become partially clogged with clot and other fibrinous material. We have all seen this. The RNs try to prevent it by milking and stripping the tubes. But it happens, and can contribute to retained hemothorax after a chest tube is placed. Thus chest tube clogging appears to play a role in this significant complicaiton. This is why when you put in a chest tube in the ER the chest X ray looks great, then a few days later, with a little atelectasis and some more oozing and bleeding, you get a chest X ray and there is an un drained effusion with a chest tube sitting right in the middle. This is due to chest tube clogging. Thus efforts to keep the chest tubes open in the first few days after injury may be more effective than a few doses of Kefsol to solve this problem.

     

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