Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

Abstract

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

Risk Factors and Events in the Adult Intensive Care Unit Associated With Pain as Self-Reported at the End of the Intensive Care Unit Stay

“…Fourth, we could not analyze the impact of analgesic or sedative drug dosages or nonpharmacological therapies used during the procedures or the implementation of life support therapies. Fifth, we did not record details concerning chest drain-related procedures [30,31]. Drain size (e.g., indwelling small catheter, small-bore chest drain, large-bore chest drain), use of premedication and/or local anesthesia, con rmation of the insertion site via ultrasonography or needle suction, chest wall dissection (by nger, curved hemostat or clamp, or trocar), and parietal refection and sutures (none, "mattress" suture, or "purse string" suture) would enable better understanding the self-perceived pain.…”

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

“…Fourth, we could not analyze the impact of analgesic or sedative drug dosages or nonpharmacological therapies used during the procedures or the implementation of life support therapies. Fifth, we did not record details concerning chest drain-related procedures [32,33]. Drain size (e.g., indwelling small catheter, small-bore chest drain, large-bore chest drain), use of premedication and/or local anesthesia, con rmation of the insertion site via ultrasonography or needle suction, chest wall dissection (by nger, curved hemostat or clamp, or trocar), and parietal refection and sutures (none, "mattress" suture, or "purse string" suture) would enable better understanding the self-perceived pain.…”

Comparison of Treatment Efficacy of the Pigtail Catheter and the Chest Tube in the Treatment of Iatrogenic Pneumothorax

“…Bu durum hastanede kalış süresini de etkilemektedir. Hastanede kalış süresinin kısalması ile morbiditemortalite oranları azalmakta ve hasta maliyeti de düşmektedir (18)(19)(20) .…”