Thoracentesis, Chest Tubes, and Tunneled Chest Drains

Abstract

Chest drainage has been practiced for numerous centuries. The earliest open drainage of complex pleural effusions dates back to the 5th century BC from Hippocrates. 1 Over the course of centuries, the ability to perform the procedure and drain fluid has become more sophisticated. Drainage has evolved to the modern-day practice of using chest tubes from the metal cannulas and trocars used in the 15th century by Celsius. The practice of water seal drainage was first described in the 19th century by Playfair and is the basis for drainage of most effusions today. 1 Chest drainage is performed by multiple specialties including emergency medicine physicians, internal medicine, pulmonologists, critical care physicians, surgeons, and interventional radiologists.The treatment of pleural effusions by interventional radiology ranges from simple drainage with thoracentesis to the placement of one or multiple indwelling chest tubes, or even a tunneled chest tube depending on the underlying etiology of the pleural effusion.

Ultrasound-Assisted and Ultrasound-Guided Thoracentesis: An Educational Review

“…Since the ultrasound-guided procedure is characterized by several disadvantages, an ultrasound-assisted approach is preferred for most of the pleural procedures [ 19 ]. The need of keeping the probe with one hand adds complexity and limits the possibilities of the free hand to touch the rib border and guide the access of the needle [ 22 ]. Moreover, the needle is often difficult to identify in real time, as the needle tip and the midpoint appear the same [ 22 ].…”

“…The need of keeping the probe with one hand adds complexity and limits the possibilities of the free hand to touch the rib border and guide the access of the needle [ 22 ]. Moreover, the needle is often difficult to identify in real time, as the needle tip and the midpoint appear the same [ 22 ]. Paying attention to the needle guide in real time can distract the operator from the execution of the procedure [ 19 ].…”

“…When arteries move to the middle of the intercostal space are at a greater risk of laceration, and a new site for the procedure should be considered [ 31 ]. Furthermore, it is useful to evaluate the presence of any wall masses or pleural thickenings at the needle insertion site, for any risk of bleeding or failure of the procedure [ 22 ].…”

“…Eventually, it is suitable to measure the insertion depth necessary to reach the pleural fluid as a security control [ 23 ]. The angle of the insertion should be reconsidered when the pleural fluid is not obtained at the expected distance [ 19 , 22 ]. The depth necessary to reach the atelectatic lung should be measured and should never be exceeded, and this is particularly relevant for tiny effusions and for overweight or oedematous patients [ 19 , 22 ].…”

“…To perform a thoracentesis, the patient is usually positioned seated, slightly bent forward and hugging a pillow [ 22 ] ( Figure 6 ).…”