Chest Tube Thoracostomy Case Study

Chest tube thoracostomy or chest tube placement may be indicated for chest traumas that include pneumothorax or hemothorax. A pneumothorax occurs when the resting negative pressure in the pleural space is lost leading to lung collapse. Pneumothoraces can occur spontaneously (primary pneumothorax) or because of penetrating or blunt trauma (secondary pneumothorax). In penetrating trauma, the open wound allows air to enter the pleural space from the atmosphere. Blunt chest trauma can result in lung injury such as laceration from rib fracture allowing air to escape into the pleural space from the lung. Pneumothorax can include symptoms including anxiety, pleuritic chest pain, dyspnea, cough, and tachypnea. Hemothorax occurs when chest injury causes bleeding that collects into the pleural space. Hemothoraces can occur in …show more content…
This pain can be lessened with analgesia and local anesthetic. Other risks associated with chest tube placement include injury to nerve, artery or vein, bleeding, and infection at the site of insertion with rates of complications ranging from 3% - 18% (Kuhajda et al. 2014). Chest tube thoracostomy management can be further complicated by persistent or recurrent pneumothorax, persistent air leak, and clotting of the tube (Mowery et al. 2011). ATLS recommends thoracostomy tube size 32-40 French for traumatic pneumothorax or hemothorax to reduce the risk of kinking or clotting of the tube (Advanced Trauma Life Support). A chest x-ray should be obtained immediately after placement of chest tube to confirm correct placement. Per a review of current literature, thoracostomy tubes should initially be placed to -20cm suction (Davis et al. 1994). Hemothorax in trauma patients requiring chest tube placement with >1500mL initial output or >200mL/hour for 3 hours should be taken to the operating room for exploration of the chest for thoracic injury and control of bleeding (Martin et al.