Indications for Chest-Tube Insertion.
--Emergency
.Pneumothorax
In all patients on mechanical ventilation
When pneumothorax is large
In a clinically unstable patient
For tension pneumothorax after needle decompression
When pneumothorax is recurrent or persistent
When pneumothorax is secondary to chest trauma
When pneumothorax is iatrogenic, if large and clinically significant
.Hemopneumothorax
.Esophageal rupture with gastric leak into pleural space
--Nonemergency
.Malignant pleural effusion
.Treatment with sclerosing agents or pleurodesis
.Recurrent pleural effusion
.Parapneumonic effusion or empyema
.Chylothorax
.Postoperative care (e.g., after coronary bypass, thoracotomy, or lobectomy)
Contraindications:
* The need for emergent thoracotomy is an absolute contraindication to tube
thoracostomy.
* Relative contraindications include the following:
o Coagulopathy
o Pulmonary bullae
o Pulmonary, pleural, or thoracic adhesions
o Loculated pleural effusion or empyema
o Skin infection over the chest tube insertion site
Complications:
The most important complications associated with chest-tube insertion include
bleeding and hemothorax due to intercostal artery perforation, perforation of vis-
ceral organs (lung, heart, diaphragm, or intraabdominal organs), perforation of major vascular structures such as the aorta or subclavian vessels, intercostal neuralgia due to trauma of neurovascular bundles, subcutaneous emphysema, reexpansion pulmonary edema, infection of the drainage site, pneumonia, and empyema. There may be technical problems such as intermittent tube blockage from clotted blood, pus,
lines for the insertion of a chest drain.
or debris, or incorrect positioning of the tube, which causes ineffective drainage.
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