It also serves as a route to instill antibiotics (post-pneumonectomy empyemas), sclerosing agents (pleurodesis), as well as fibrinolytics, DNAse, and/or saline (complicated parapneumonic effusions and empyemas). The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.Ĭhest tube placement (also called tube thoracostomy) is a common procedure in daily clinical practice which is performed to drain fluid, blood, or air from the pleural cavity. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. A drain-clamping test before tube withdrawal is generally not advocated. The optimal timing for tube removal is still a matter of controversy however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. The so-called trocar technique must be avoided. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity.
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