Abstract
Chest tubes are the gold standard for the drainage of the pleural and pericardial spaces. They are an integral part of cardiothoracic surgery, and the well-being of patients depends on their appropriate management. Chest tubes are used to treat a variety of conditions including pneumothorax, pleural effusion, and postoperative evacuation of air and fluid. There are a number of types and sizes of chest tubes available. This chapter will discuss the indications for chest tube placement and removal as well as the best uses for different types of chest tubes. We will address complications associated with chest tube placement and lastly will discuss special situations such as bronchopleural fistula, post-pneumonectomy chest tubes, abrupt changes in chest tube output, and clamping chest tubes.
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References
Venuta F, Diso D, Anile M, Rendina E, Onorati I. Chest tubes. Thorac Surg Clin. 2017;27(1):1–5.
Moss E, Miller C, Jensen H, Basmadjian A, Bouchard D, Carrier M, et al. A randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes. Interact Cardiovasc Thorac Surg. 2013;17(1):110–5.
Cooke D, David E. Large-bore and small-bore chest tubes. Thorac Surg Clin. 2013;23(1):17–24.
Frankel T, Hill P, Stamou S, Lowery R, Pfister A, Jain A, et al. Silastic drains vs conventional chest tubes after coronary artery bypass. Chest. 2003;124(1):108–13.
Havelock T, Teoh R, Laws D, Gleeson F. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):i61–76.
McElnay P, Lim E. Modern techniques to insert chest drains. Thorac Surg Clin. 2017;27(1):29–34.
Filosso P, Sandri A, Guerrera F, Roffinella M, Bora G, Solidoro P. Management of chest drains after thoracic resections. Thorac Surg Clin. 2017;27(1):7–11.
Sakakura N, Fukui T, Mori S, Hatooka S, Yokoi K, Mitsudomi T. Fluid drainage and air evacuation characteristics of Blake and conventional drains used after pulmonary resection. Ann Thorac Surg. 2009;87(5):1539–45.
Filosso P, Sandri A, Guerrera F, Ferraris A, Marchisio F, Bora G, et al. When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters. J Thorac Dis. 2016;8(7):E503–10.
Miller K, Sahn S. Chest tubes* indications, technique, management and complications. Chest. 1987;91(2):258–64.
Kim S, Khalpey Z, Daugherty S, Torabi M, Little A. Factors in the selection and management of chest tubes after pulmonary lobectomy: results of a national survey of thoracic surgeons. Ann Thorac Surg. 2016;101(3):1082–8.
Alex J, Ansari J, Bahalkar P, Agarwala S, Ur Rehman M, Saleh A, et al. Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy. Ann Thorac Surg. 2003;76(4):1046–9.
Zhou D, Deng X, Liu Q, Chen Q, Min J, Dai J. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis. J Cardiothorac Surg. 2016;11(1):88.
Brunelli A, Beretta E, Cassivi S, Cerfolio R, Detterbeck F, Kiefer T, et al. Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg. 2011;40(2):291–7.
Pearson F, Patterson G. Pearson’s thoracic & esophageal surgery. 1st ed. Philadelphia: Churchill Livingstone/Elsevier; 2008.
Terzi A, Feil B, Bonadiman C, Lonardoni A, Spilimbergo I, Pergher S, et al. The use of flexible spiral drains after non-cardiac thoracic surgery. A clinical study. Eur J Cardiothorac Surg. 2005;27(1):134–7.
Clark G, Licker M, Bertin D, Spiliopoulos A. Small size new silastic drains: life-threatening hypovolemic shock after thoracic surgery associated with a non-functioning chest tube. Eur J Cardiothorac Surg. 2007;31(3):566–8.
Gocyk W, Kużdżał J, Włodarczyk J, Grochowski Z, Gil T, Warmus J, et al. Comparison of suction versus nonsuction drainage after lung resections: a prospective randomized trial. Ann Thorac Surg. 2016;102(4):1119–24.
Cerfolio R, Bass C, Katholi C. Prospective randomized trial compares suction versus water seal for air leaks. Ann Thorac Surg. 2001;71(5):1613–7.
Le J, Buth K, Hirsch G, Légaré J. Does more than a single chest tube for mediastinal drainage affect outcomes after cardiac surgery? Can J Surg. 2015;58(2):100–6.
Davies H, Mishra E, Kahan B, Wrightson J, Stanton A, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion. JAMA. 2012;307(22):2383.
PleurX™ Resources – BD [Internet]. Carefusion.com. 2017 [cited 22 April 2017]. Available from: http://www.carefusion.com/our-products/interventional-specialties/drainage/about-the-pleurx-drainage-system/pleurx-resources.
Warren W, Kim A, Liptay M. Identification of clinical factors predicting Pleurx® catheter removal in patients treated for malignant pleural effusion☆. Eur J Cardiothorac Surg. 2008;33(1):89–94.
Wahidi M, Reddy C, Yarmus L, Feller-Kopman D, Musani A, Shepherd R, et al. Randomized trial of pleural fluid drainage frequency in patients with malignant pleural effusions. The ASAP trial. Am J Respir Crit Care Med. 2017;195(8):1050–7.
Playfair. Reports of medical and surgical practice in the Hospitals of Great Britain. BMJ. 1875;2(769):396–7.
Kam A, O’Brien M, Kam P. Pleural drainage systems. Anaesthesia. 1993;48(2):154–61.
Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58(Supplement 2):ii39–52.
Cerfolio R. Chest tube management after pulmonary resection. Chest Surg Clin N Am. 2002;12(3):507–27. Sargeant J, Hoffa J. Pleural Drainage System. US; 4,439,189, 1984.
Dernevik L, Belboul A, Rådberg G. Initial experience with the world's first digital drainage system. The benefits of recording air leaks with graphic representation. Eur J Cardiothorac Surg. 2007;31(2):209–13.
Cerfolio R, Bryant A. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg. 2008;135(2):269–73.
Brunelli A, Varela G, Refai M, Jimenez M, Pompili C, Sabbatini A, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg. 2010;90(1):204–9.
Cerfolio R, Minnich D, Bryant A. The removal of chest tubes despite an air leak or a pneumothorax. Ann Thorac Surg. 2009;87(6):1690–6.
Mao M, Hughes R, Papadimos T, Stawicki S. Complications of chest tubes: a focused clinical synopsis. Curr Opin Pulm Med. 2015;21(4):376–86.
John M, Razi S, Sainathan S, Stavropoulos C. Is the trocar technique for tube thoracostomy safe in the current era?: Table 1. Interact Cardiovasc Thorac Surg. 2014;19(1):125–8.
Stawicki S, Sarani B, Braslow B. Reexpansion pulmonary edema. OPUS 12 Sci. 2008;2(2):29–31.
Chan L, Reilly K, Henderson C, Kahn F, Salluzzo R. Complication rates of tube thoracostomy. Am J Emerg Med. 1997;15(4):368–70.
Helling T, Gyles N, Eisenstein NC, Soracco C. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma Inj Infect Crit Care. 1989;29(10):1367–70.
Cerfolio R, Bryant A. The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg. 2008;86(2):396–401.
Cerfolio R, Bryant A. The management of chest tubes after pulmonary resection. Thorac Surg Clin. 2010;20(3):399–405.
Bjerregaard L, Jensen K, Petersen R, Hansen H. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg. 2013;45(2):241–6.
Cerfolio R, Bryant A, Skylizard L, Minnich D. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg. 2013;145(6):1535–9.
McCormick J, O’Mara M, Papasavas P, Caushaj P. The use of routine chest x-ray films after chest tube removal in postoperative cardiac patients. Ann Thorac Surg. 2002;74(6):2161–4.
Sepehripour A, Farid S, Shah R. Is routine chest radiography indicated following chest drain removal after cardiothoracic surgery? Interact Cardiovasc Thorac Surg. 2012;14(6):834–8.
Funk G, Petrey L, Foreman M. Clamping thoracostomy tubes: a heretical notion? Baylor Univ Med Proc. 2009;22(3):215–7.
Ali J, Qi W. Effectiveness of chest tube clamping in massive hemothorax. J Trauma Inj Infect Crit Care. 1995;38(1):59–63.
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Wilson, H.K., Teeter, E.G., Kolarczyk, L.M., Haithcock, B., Long, J. (2019). Troubleshooting Chest Drains. In: Slinger, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-00859-8_58
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DOI: https://doi.org/10.1007/978-3-030-00859-8_58
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