Chest Tube Insertion

Hendy Buana Vijaya

Pembimbing :
dr. Agus Suhendar Sp. BS
Chest tube

 Chest tube (thoracic drainage catheter) atau tube

thoracostomy berupa tube (tabung/pipa/selang)
plastik yang fleksibel yang dimasukkan melalui sisi
dada ke dalam rongga pleural.
Indication

 Pneumothoraks
 Hemothoraks
 Efusi pleura
 Chylothoraks
Indication

 Pneumothoraks
 Hemothoraks
 Efusi pleura
 Chylothoraks
Hemothorax

Hemothorax is a type of pleural effusion in which blood

(<1500 mL) accumulates in the pleural cavity.
The primary cause of hemothorax is laceration of :
 Lung
 Great vessels
 Intercostal vessels
 An internal mammary artery (internal thorasic artery)
Anatomi
Chest tube insertion

 Step 1
Determine the insertion site, usually at the nipple level (fifth intercostal space),
just anterior to the midaxillary line on the affected side. A second chest tube
may be used for a hemothorax
 Step 2
Surgically prepare and drape the chest at the predetermined site of the tube
insertion.
 Step 3
Locally anesthetize the skin and rib periosteum.
 Step 4
Make a 2 to 3 cm transverse (horizontal) incision at the predetermined site and
blunty dissect through the subcutaneous tissues, just over the top of the rib
 Step 5
Puncture the parietal pleura with the tip of a clamp and put a gloved into the
incision to avoid injury to other organs and to clear any adhesions, clots and so
on. Once the tube in the proper place, remove the clamp from the tube
 Step 6
Clamp the proximal end of the thoracostomy tube and advance it into the pleural
space to the desired length. The tube should be directed posteriorly along the
inside of the chest wall
 Step 7
Look for “fogging” of the chest tube with the expiration or listen for air
movement.
 Step 8
Connect the end of the thoracostomy tube to an underwater seal apparatus
 Step 9
Suture the tube in place
 Step 10
Apply on occlusive dressing and tape the tube to the chest
 Step 11
Obtain a chest X-ray film
 Step 12
Obtain arterial blood gas value and/or institute pulse oximetry monitoring as
necessary.

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Komplikasi pemasangan chest tube

1. Laserasi atau tertusuknya organ intrathorakal dan/atau intraabdominal

2. Pleural infection contohnya thoracic empyema
3. Kerusakan dari nervus, arteri dan vena intercostal
4. Chest tube kaku, tersumbat atau dari proses pencabutan dari dinding dada,
atau terputusnya chest tube dari WSD
5. Persistent pneumothorax
6. Subcutaneous emphysema
7. Rekurensi pneumothorax pada pengangkatan dari chest tube
8. Paru gagal untuk mengembang karena masuk ke bronkus
9. Anafilaksis atau reaksi alergi pada persiapan operasi atau anestesi.