chest tube

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chest

 [chest]
barrel chest a rounded, bulging chest with abnormal increase in the anteroposterior diameter, showing little movement on respiration; seen in emphysema, kyphosis, and chronic airflow limitation.
Barrel chest. From Herlihy et al., 2000.
flail chest see flail chest.
funnel chest pectus excavatum.
pigeon chest pectus carinatum.
chest tube a tube inserted into the thoracic cavity for the purpose of removing air or fluid, or both. Chest tubes are attached to a closed drainage system (see illustration) so that normal pressures within the alveoli and the pleural cavity can be restored. These pressures are essential to adequate expansion and reinflation of the lung.

Chest tubes are indicated when the normally airtight pleural space has been penetrated through surgery or trauma, when a defect in the alveoli allows air to enter the intrapleural space, and when there is an accumulation of fluid, as from pleural effusion. The effect of excessive amounts of air and fluid within the pleural space is collapse of the lung and the danger of mediastinal shift.
Patient Care. It is important that those responsible for the personal care of a patient who has chest tubes inserted understand the basic mechanics of inflation and deflation of the lung, and the purpose of the tubes and their location in each patient. In some cases one tube is inserted higher in the thorax (usually in the 2nd intercostal space) to remove air, and a second tube is placed lower (in the 8th or 9th intercostal space) to drain off fluids.

Chest tubes may be connected to a variety of closed drainage systems: a water-seal drainage system with one, two, or three bottles; and a self-contained system such as Pleur-evac. Whatever the type, the purpose of the system is to allow for drainage from the pleural cavity to the outside and at the same time prevent the entry of atmospheric air into the pleural cavity.

Precautions that must be taken in the maintenance of the drainage system are:

1. The bottles and collection apparatus of the system must be kept below the level of the chest to prevent backflow.

2. The lumens of the tubes must be kept open to allow for drainage. If they are obstructed there will be no fluctuation of the fluid level in the glass tube that is connected to the chest tube at one end and kept under water in the bottle at the other end. In the Pleur-evac, the liquid in the chamber should rise on the right side and fall on the left side. If there is evidence that the system is not working properly, this must be attended to immediately. Occlusion of the tubes can lead to a buildup of air and fluids in the pleural cavity and creation of a tension pneumothorax.

3. The system must be a closed (airtight) system. There can be no leaks around connections, and the lower end of the glass tube must remain under water in the bottle.

The amount, color, and consistency of the fluid drainage should be checked at least once each hour for the first 24 hours after surgery. The chest tubes should be milked and stripped every one to two hours to assure patency and adequate drainage. The amount of air being removed is indicated by occasional bubbling in the water-seal chamber. Excessive bubbling may indicate air leaks in the tubing.

An important aspect of patient care is proper positioning to maintain adequate drainage. The positions allowed and the amount of mobility permitted will depend on the patient's surgical diagnosis, the placement of the tube(s), and preference of the attending physician. Frequent turning, coughing, and deep breathing are instituted on a regular basis to avoid serious pulmonary complications. An exception to the rule of turning is the pneumonectomy patient, who is placed in high Fowler's position and not turned for at least 24 hours after surgery. Chest physical therapy and intermittent positive pressure breathing (IPPB) treatments usually are ordered for all patients with chest tubes. Some patients may require a ventilator during the immediate postoperative period.

The patient is observed for signs of respiratory distress and a buildup of air and fluid within the pleural cavity. Early correction of this condition can prevent mediastinal shift. Other signals that demand immediate attention are persistent bubbling in the underwater seal (fluid should fluctuate in the tube as the patient breathes), a drainage through the tube that accumulates at a rate of more than 100 ml per hour, leakage of air at the junctions of the chest tube and tubing and bottles or self-contained unit, and a “putty” appearance caused by the leakage of air into subcutaneous tissues in the upper chest and neck. After a chest tube is removed, the wound is promptly sealed with a sterile petroleum jelly dressing to occlude the opening and prevent entry of air into the pleural space.
 One-, two-, and three-bottle methods for providing a closed drainage system. A, In the one-bottle system the drainage via the chest tube enters the bottle through the glass tube which has one end submerged under water to form a seal. This provides a one-way valve that prevents a backflow of air into the pleural cavity, which could collapse the lung. As fluid and air from the pleural cavity enter the drainage bottle, the air that is displaced in the bottle is vented through the short tube above water level. B, The second bottle in the two-bottle system acts as a trap to control and decrease the amount of suction within the chest tube. Otherwise, the suction might be too forceful and damage the pleural membrane. No drainage enters this bottle. Its only purpose is to control the force of suction applied. C, The third bottle in the three-bottle system also is used to regulate the amount of suction. This can be done by adjusting the length of the glass tube that is under water.
 Pleur-evac Adult/Pediatric Chest Drainage Model A-6000. The Pleur-evac Chest Drainage Systems have been the world's most popular units since their inception in 1967. (Courtesy of Deknatel, Inc., Fall River, MA.)

tube

 [to̳b]
a hollow cylindrical organ or instrument. adj., adj tu´bal.
auditory tube eustachian tube.
Blakemore-Sengstaken tube Sengstaken-Blakemore tube.
chest tube see chest tube.
Dobhoff tube a small-lumen feeding tube that can be advanced into the duodenum.
drainage tube a tube used in surgery to facilitate escape of fluids.
Drieling tube a double-lumen tube having a metal weight at one end to carry it past the stomach into the duodenum. At the other end are two tails, one used to collect gastric specimens and the other to collect specimens from the duodenum. The tube is used in the secretin test for pancreatic exocrine function.
Durham's tube a jointed tracheostomy tube.
endobronchial tube a single- or double-lumen tube inserted into the bronchus of one lung and sealed with an inflatable cuff, permitting ventilation of the intubated lung and complete deflation of the other lung; used in anesthesia and thoracic surgery.
endotracheal tube see endotracheal tube.
esophageal tube stomach tube.
eustachian tube see eustachian tube.
Ewald tube a large lumen tube used in gastric lavage.
fallopian tube see fallopian tube.
feeding tube one for introducing high-caloric fluids into the stomach; see also tube feeding.
tube feeding a means of providing nutrition via a feeding tube inserted into the gastrointestinal tract; it may be done to maintain nutritional status over a period of time or as a treatment for malnutrition. It can be used as the only source of nutrition or as a supplement to oral feeding or parenteral nutrition.

Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes. Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis.

There are commercially prepared formulas for tube feeding. Some contain all six necessary nutrients (carbohydrates, fats, proteins, vitamins, minerals, and trace elements) and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs. Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube.
Patient Care. In addition to frequent and periodic checking for tube placement and monitoring of gastric residuals to prevent aspiration, other maintenance activities include monitoring effectiveness of the feeding and assessing the patient's tolerance to the tube and the feeding. Special mouth care is essential to maintain a healthy oral mucosa. A summary of the complications related to tube feeding, their causes and contributing factors, and interventions to treat or prevent each complication is presented in the accompanying table.
fermentation tube a U-shaped tube with one end closed, for determining gas production by bacteria.
Levin tube a gastroduodenal catheter of sufficiently small caliber to permit transnasal passage; see illustration.
Two types of nasogastric tubes. From Ignatavicius et al., 1995.
Linton tube a triple-lumen tube with a single balloon used to control hemorrhage from esophageal varices. Once it is positioned under fluoroscopic control and inflated, the balloon exerts pressure against the submucosal venous network at the cardioesophageal junction, thus restricting the flow of blood to the esophageal varices.
Miller-Abbott tube see miller-abbott tube.
Minnesota tube a tube with four lumens, used in treatment of esophageal varices; having a lumen for aspiration of esophageal secretions is its major difference from the sengstaken-blakemore tube.
nasogastric tube see nasogastric tube.
nasotracheal tube an endotracheal tube that passes through the nose.
neural tube the epithelial tube produced by folding of the neural plate in the early embryo.
orotracheal tube an endotracheal tube that passes through the mouth.
otopharyngeal tube eustachian tube.
Rehfuss tube a single-lumen oral tube used to obtain specimens of biliary secretions for diagnostic study; it is weighted on one end so that it can be passed through the mouth and positioned at the point where the bile duct empties into the duodenum. See also biliary drainage test.
Salem sump tube a double-lumen nasogastric tube used for suction and irrigation of the stomach. One lumen is attached to suction for the drainage of gastric contents and the second lumen is an air vent. See illustration.
Sengstaken-Blakemore tube see sengstaken-blakemore tube.
stomach tube see stomach tube.
T-tube one shaped like the letter T and inserted into the biliary tract to allow for drainage of bile; it is generally left in place for 10 days or more in order to develop a tract through which bile can drain after the tube is removed. A T-tube cholangiogram is usually performed prior to removal of the tube in order to determine that the common duct is patent and free of stones. If stones are found they can be removed through the tube tract by instruments inserted under x-ray guidance.
test tube a tube of thin glass, closed at one end; used in chemical tests and other laboratory procedures.
thoracostomy tube a tube inserted through an opening in the chest wall, for application of suction to the pleural cavity; used to drain fluid or blood or to reexpand the lung in pneumothorax. See also chest tube.
tracheal tube endotracheal tube.
tracheostomy tube a curved endotracheal tube that is inserted into the trachea through a tracheostomy; see discussion under tracheostomy.
tympanostomy tube ventilation tube.
uterine tube fallopian tube.
ventilation tube a tube inserted after myringotomy in chronic cases of middle ear effusion, such as in secretory or mucoid otitis media; it provides ventilation and drainage for the middle ear during healing, and is eventually extruded. Called also tympanostomy tube.
Tympanostomy (ventilation) tube. Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Tubes extrude spontaneously in 6 months to 1 year. From Jarvis, 1996.
Wangensteen tube a small nasogastric tube connected with a special suction apparatus to maintain gastric and duodenal decompression.
Whelan-Moss T-tube a t-tube whose crossbar tube is larger in diameter than the drainage tube.
x-ray tube a glass vacuum bulb containing two electrodes; electrons are obtained either from gas in the tube or from a heated cathode. When suitable potential is applied, electrons travel at high velocity from cathode to anode, where they are suddenly arrested, giving rise to x-rays.

chest tube

a catheter inserted through the rib space of the thorax into the pleural space to remove air and/or fluid, thereby restoring negative pressure in the pleural space. It is attached to a water-seal chest drainage device. It is commonly used after chest surgery and lung collapse.
enlarge picture
Placement of chest tubes

chest tube

Thoracostomy A tube, placed under negative pressure in the pleura cavity, to drain fluid

chest tube

(chest tūb)
A tube introduced into the intrapleural space to evacuate gas or liquid.

tube

a hollow cylindrical organ or instrument.

chest tube
one or more tubes inserted into the pleural space to provide relief from either pneumothorax or accumulations of fluid within the thoracic cavity and to allow for re-expansion of the lung.
drainage tube
a tube used in surgery to facilitate escape of fluids. See also drain (2).
endobronchial tube
a double-lumen tube inserted into the bronchus of one lung, permitting complete deflation of the other lung; used in anesthesia and thoracic surgery.
eustachian tube
feeding tube
one for administering food into the alimentary tract. See also enterostomy tube, jejunostomy tube, tube gastrostomy, nasoesophageal tube (below).
fermentation tube
a U-shaped tube with one end closed, for determining gas production by bacteria. Called also Durham tube.
Levin tube
a gastroduodenal catheter of sufficiently small caliber to permit transnasal passage.
nasoesophageal tube
a feeding tube introduced through the nares and nasal cavity, then into the esophagus. Used in enteral feeding of dogs and cats.
otopharyngeal tube
auditory tube.
pharyngostomy tube
see pharyngostomy intubation.
photomultiplier tube
a vacuum tube that produces an electric current proportional to the intensity of light falling on its photocathode; it is sensitive enough to detect single photons.
tube rating chart
provided by the manufacturer and containing the specifications for the safe operating limits of the x-ray tube in terms of kilovolt peak, milliamps and time.
stomach tube
a flexible tube used for introducing food, medication, or other material directly into the stomach, or for removal of undesirable contents from the stomach. It can be passed into the stomach via the nose or mouth. Passage via the mouth requires the protection of a mouth speculum.
suction drainage tube
see suction drainage.
test tube
a tube of thin glass, closed at one end; used in chemical tests and other laboratory procedures.
thoracostomy tube
one inserted through an opening in the chest wall for application of suction to the pleural cavity to facilitate re-expansion of the lung in spontaneous pneumothorax. See also chest tube (above).
References in periodicals archive ?
They tried 16 injections and a complex chest drain, but at 18st 3lbs the 56-year-old was carrying too much weight for the procedures to work.
He had suffered a four-centimetre stab wound beneath his shoulder blade, his lung was punctured and surgeons had to insert a chest drain during his week-long stay in hospital.
And in January 2006 she mistakenly ordered a chest drain to be inserted in an elderly woman at the Royal Gwent Hospital after examining the wrong X-ray, causing the patient an unnecessary injury.
An earlier disciplinary hearing had also heard that a failure by Dr Abdul-Salam to realise she had the wrong X-ray led to an elderly woman being fitted with an unnecessary chest drain.
As one of the first thoracic surgeons in the United States, Heimlich developed a chest drain valve used to remove blood from the chest cavity which is still used today more than 120,000 times a year in both hospital and battlefield surgeries.
Four days after the machine was switched off, Frankie was still fighting for her life, and doctors put in a chest drain after one of her lungs collapsed.
The court heard a medical registrar had replaced the original chest drain with another, and it is believed this drain was the cause of Mr Davies' death.
Clinical chairman Anton Meyer (George Irving) took the call in the operating theatre where he was performing heart surgery and passed on instructions on how to insert a chest drain.
After she was born, doctors inserted a chest drain into baby Courtney, whose parents are from Gilfach Goch, to relieve the pressure on her lungs, but this led to internal haemorrhaging and she died three days later on June 27.
Surgeons there twice had to insert a chest drain to clear fluid from his lung.
He had been taken to hospital, where he needed a chest drain to repair a punctured lung.
Paul only survived the onslaught by playing dead; A doctor at Glasgow Royal Infirmary's accident and emergency unit inserts a chest drain into a man who has been stabbed