Chest Tubes

Your lungs are each surrounded by two layers of membrane. These membranes are called pleura. The space between the layers is called the pleural space. Normally the pleural space has a tiny amount of fluid in it. But excess fluid, blood, pus, or air in the pleural space makes it hard for the lung to expand and makes breathing difficult. A chest tube is a soft, flexible tube put into the pleural space. The tube drains blood, air, or excess fluid. The tube is inserted through a small cut (incision) in the skin.

Reasons for a Chest Tube

A chest tube may be needed:

• After chest surgery or injury to the chest

• To treat a lung infection or abscess

• To treat collapsed lung

• To treat bleeding into the chest (hemothorax)

Chest Tube Placement

A chest tube is often placed during chest surgery while you’re in the operating room and still sedated (asleep). If you have a lung infection or other problem, you may have a chest tube placed while you’re awake in your hospital room. The procedure takes less than 30 minutes. Here’s how it is done:

• Your blood pressure, pulse, and temperature are taken.

• You lie on your side or sit in a semi-upright position. You will be asked to put one arm up over your head.

• An injection of anesthetic is used to numb the area where the chest tube is placed. You may be given medication to sedate you (make you sleep). Sedation is delivered by a mask or an intravenous (IV) line in your hand or arm.

• A small incision is made in your side, chest, or back. A soft, flexible tube is inserted into the incision site. The tube is guided between your ribs until it reaches the pleural space. Live ultrasound imaging may be used to help place the tube correctly.

• The tube may be sutured (sewn) to your skin to keep it in place. It will also be covered with an airtight bandage. The tubing will be taped to your body and bed sheet. This is to keep it from being pulled out accidentally.

• The tube is then connected to a drainage device.

  • A chest drainage unit pulls the excess fluid, blood, pus, or air from your chest. The device should be lower than your chest level and may be put on the floor. It contains water. It may make a bubbling sound while it’s working.

  • A Heimlich valve (or flutter valve) is a small one-way valve. It is used if you have pneumothorax. This is a collapsed lung due to collection of air in the pleural space. The valve is attached directly to the end of your chest tube. The valve opens to let air escape from the chest tube. It then closes to prevent air from going back in the tube. You may go home from the hospital with your chest tube attached to a Heimlich valve. Care for it as instructed.

• An x-ray may be done to help confirm that the tube is in the right position.

While the Tube Is in Place

• The tube is in place for 1-4 days. You may be in the hospital until after the tube is removed. You are given pain medication by mouth or by IV. You may have a patient-controlled analgesia (PCA) pump attached to the IV line. This lets you give yourself pain medication.

• You may need extra oxygen. This is given through a mouth mask or a flexible tube under your nose. You may also be connected to a small device called a pulse oximeter. It measures the amount of oxygen in your blood. It is placed on your finger, toe, or ear.

• After the tube is placed, you can help with drainage by:

  • Breathing deeply

  • Coughing

  • Sitting upright

  • Moving and walking around

• You can reduce discomfort by holding a pillow tightly to your chest when you cough.

• Your breathing and heart rate will be monitored. The tubing will be checked regularly. If blood is draining from your chest, the tubing will be checked for clots. If a clot appears, the tubing may be squeezed to move the clot out of the tube. If fluid is draining from your chest, it may be tested for signs of infection. You may need antibiotics to prevent or treat infection.

• Tell a nurse right away if you have trouble breathing or chest, shoulder, or neck pain.

Risks and Possible Complications of Chest Tubes

A chest tube can have some risks. But the benefits of having the tube usually outweigh the risks. Risks of a chest tube include:

• Air leak

• Infection

• Bleeding

• Reaction to anesthesia used during placement

Removal of the Chest Tube

When the air, blood, pus, or excess fluid is gone from the pleural space, the tube is removed. This may be done in your hospital bed. You may receive more pain medication before the tube is removed. As the tube is removed, you may be asked to inhale or exhale deeply and then hold your breath. After the tube is removed, the incision may be closed with sutures. Or the incision may be left to close by itself. A bandage is placed over the incision. You may have an x-ray after the tube is removed. This is to make sure your lung is still inflated.

Follow-Up Care

After the tube is removed:

• Follow up with the doctor within 48 hours. You may have another x-ray. This is to check for fluid or air in your lung. The incision will be checked to make sure it is healing. The bandage may be replaced with a smaller adhesive bandage. You may change the adhesive bandage as often as needed.

• Care for the insertion site(s) as directed. Keep the bandage in place for 48 hours. Keep it dry.

• Until a scab has formed on the incision site, you may shower but not take a bath. When a scab has formed you no longer need an adhesive bandage. After the incision has healed you may have a small scar.