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The pleural space is the area between the lung and the chest wall. If air, blood, or fluid gets into this space, it can be a problem. This air, fluid, or blood can cause one or both lungs to collapse, which makes breathing difficult. A chest tube can drain the pleural space. This tube is soft and flexible. Your child may need a chest tube to prevent his or her lung from collapsing. Or he or she may need it to allow the lung to expand after collapsing.
Your child may need a chest tube:
Following lung or heart surgery.
Due to fluid in the pleural space from a lung infection (pneumonia).
Because of a problem with the lungs at birth.
Following an injury to the chest, such as a broken rib.
Due to a collapsed lung.
You can help your child have a better experience by preparing him or her in advance. How you do this depends on your child’s needs. (Of course, this may not be possible if the procedure has been done in an emergency.)
Explain the procedure to your child in brief and simple terms. Younger children tend to have shorter attention spans, so do this shortly before the procedure. Older children should be given more time to understand the procedure in advance.
If your child will be awake during the procedure, describe how it will feel as best you can. Also, prepare your child for what to expect afterward. Allow your child to ask questions.
Use play when helpful. This can involve role-playing with a child’s favorite toy or object. Older children may want to see pictures or films that show them clearly what will happen during the procedure.
A doctor places a chest tube in the operating room after surgery while your child is still asleep or sedated. This can also happen in an emergency or radiology department, or at the hospital bedside. The procedure takes less than 30 minutes. Here’s what you can expect:
Your child will first receive pain medication. Local anesthesia numbs the skin where the chest tube is placed. Your child will also receive medication (called anesthesia) to make him or her sleep. Anesthesia is delivered by a mask or an intravenous (IV) line.
A long, flexible tube is hooked up to a suction device.
A small incision is made under a rib into the area between your child’s lung and its lining, where the tube will be placed.
The doctor may use ultrasound, which shows pictures of the inside of your child’s body. These pictures help the doctor place the tube.
The doctor may stitch (suture) the tube to the skin. The site is then covered with a bandage (dressing).
The doctor may do an x-ray to help confirm that the tube is in the right position.
Your child is given pain medications by mouth or by IV line. An older child may have a patient-controlled analgesia (PCA) pump attached to the IV line. This allows your child to give himself or herself pain medications.
The drainage tube is connected to a container on the floor. This container holds sterile water. It makes a bubbling sound during suctioning.
Your child may need antibiotics to prevent or treat infection.
Your child has the tube in place for 1–4 days. Once the fluid, blood, or air is gone, the tube is removed. This is often done at the bedside.
Before removing the tube, the doctor clamps it and x-rays the area, checking for any air or fluid. Your child may receive pain medications before the tube is removed.
Depending on your child’s condition, you can take him or her home after the tube is removed.
Follow up with the doctor within 48 hours. At this time, the doctor will check that the incision is healing and may take more x-rays to check for fluid and how well the lung is recovering.
After the procedure, you can help with drainage or healing by:
Encouraging deep breathing and coughing.
Encouraging your child to move and walk around. Ask the doctor or nurse about safe activities for your child.
Feeding your child normal foods, if the doctor or nurse says it’s okay.
After the doctor removes the tube, stitches may be used to close the incision. Or the incision is allowed to close by itself. Then a dressing is placed over the incision and kept in place for 48 hours, followed by use of an adhesive bandage. Here are some guidelines for wound care:
Once a scab has formed, you can leave the area open to the air to help with healing.
Your child may shower, but not bathe until a full scab has formed.
After the incision has healed, your child may have a small permanent scar.
While your child is in the hospital, healthcare providers will watch for any problems that arise from having a chest tube. These are rare but can include:
Reactions to anesthesia or medications
Grunting while breathing
Sudden chest pain, or shoulder or neck pain
Fast breath or nostrils opening wide to get air
Skin on neck or between ribs pulling in with each breath
Restlessness, crying, or irritability