Chest Drainage Therapy
Chest Drainage Therapy
Chest drainage therapy involves the removal of air, blood, pus, or other secretions from the chest cavity.
Chest drainage therapy is done to relieve pressure on the lungs, and remove fluid that could promote infection. Installing a chest drainage tube can be either an emergency or a planned procedure.
Removing air or fluids from the chest involves the insertion of a tube through the skin and the muscles between the ribs, and into the chest cavity. This cavity is also called the pleural space. Insertion of this tube is called thoracostomy, and chest drainage therapy is sometimes called thoracostomy tube drainage.
Conditions that may need to be treated by chest drainage therapy include emphysema (air in the tissues of the lungs), tuberculosis, and spontaneous pneumothorax (air in the chest cavity) that causes more than a 25% collapse of the lung. Other conditions include cancer that causes excessive secretions, empyema (pus in the thoracic cavity), or hemothorax (blood in the thoracic cavity). Almost all chest drainage therapy is done to drain blood from the chest cavity after lung or heart surgery. In cases where the lung is collapsed, removing fluids by chest drainage therapy allows the lung to reinflate.
Oftentimes an x ray is performed prior to treatment to determine whether the problem is either fluid or air in the pleural space. Sometimes a procedure called thoracentesis is performed in an effort to avoid inserting a chest drainage tube. In this procedure a needle with a catheter is inserted into the pleural space and fluid is removed. When fluid continues to accumulate, chest drainage therapy is usually the next step. This is especially true when there is a lung infection underlying the fluid build-up.
Chest drainage therapy is not done if a collapsed lung is not life-threatening. It also should be avoided for patients who have blood clotting problems.
Most patients are awake when the chest drainage tube is inserted. They are given a sedative and a local anesthetic. Chest drainage tubes are usually inserted between the ribs. The exact location depends on the type of material to be drained and its location in the lungs.
An incision is made in the skin and through the muscles between the ribs. A chest tube is inserted and secured in place. The doctor connects one end of the tube to the chest drainage system.
The chest drainage system must remain sealed to prevent air from entering the chest cavity through the tube. One commonly used system is a water-seal drainage system, comprised of three compartments that collect and drain the fluid or air without allowing air to backflow into the tube. An alternative to this system is to connect the tube to a negative suction pump.
Once the tube and drainage system are in place, a chest x ray is done to confirm that the tube is in the right location, and that it is working. In some cases it may be necessary to insert more than one tube to drain localized pockets of fluid that have accumulated.
A chest x ray is usually done before the chest drainage tube is inserted. Sometimes fluid becomes trapped in isolated spaces in the lung, and it is necessary to do an ultrasound to determine where to locate the drainage tube. Computed tomography scans (CT) are useful in locating small pockets of fluids caused by cancer or tuberculosis.
Normally after the material has been removed from the chest cavity and the situation is resolved, the chest drainage tube is removed. In cases where the reason for the tube was air in the pleural cavity, the tube is clamped and left in place several hours before it is removed to make sure no more air is leaking into the space. If the patient is on mechanical ventilation, the tube is often left in place until a respirator is no longer necessary. Chest drainage therapy is usually done in conjunction with treating the underlying cause of the fluid build-up.
The fluid that has been drained is examined for bacterial growth, cancer cells, pus, and blood—to determine the underlying cause of the condition and appropriate treatment.
Problems can arise in the insertion of the tube if the membrane lining the chest cavity is thick or if it has many adhesions. The tube will not drain correctly if the chest cavity contains blood clots or thick secretions that are often associated with infections. Excessive bleeding may occur during the insertion and positioning of the tube. Infection may result from the procedure. Pain is also a common complication.
The gas, pus, or blood is drained from the chest cavity, and the lungs reinflate or begin to function more efficiently. The site at which the tube was inserted heals normally.
Empyema — Pus in the pleural cavity.
Hemothorax — Blood in the pleural cavity.
Pleural cavity — The area of the chest that includes the lining of the chest cavity, the space the lungs are located in, and the membrane covering of the lungs.
Spontaneous pneumothorax — Air in the chest cavity that occurs because of disease or other naturally occurring cause. Air and blood together in this space is called a pneumohemothorax.
McPhee, Stephen, et al., editors. Current Medical Diagnosis and Treatment, 1998. 37th ed. Stamford: Appleton & Lange, 1997.