eMedicine Specialties > Clinical Procedures > Cardiothoracic Procedures

Tube Thoracostomy

Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Contributor Information and Disclosures

Updated: Apr 21, 2008

Introduction

Trauma is the leading cause of death for individuals younger than 40 years of age, with approximately 140,000 deaths annually in the United States alone.1 Of these deaths, thoracic injuries are primarily responsible for 25% of cases2 and are a major contributing factor in up to 75% of cases.1 However, most injuries may be effectively treated with thoracostomy and simple fluid resuscitation.3,4

Tube thoracostomy is the insertion of a tube (chest tube) into the pleural cavity to drain air, blood, bile, pus, or other fluids.5 Whether the accumulation is the result of rapid traumatic filling or insidious malignant seepage, placement of a chest tube allows for continuous, large volume drainage until the underlying pathology can be more formally addressed. The list of specific treatable etiologies is extensive (see Indications), but without intervention, patients are at great risk for major morbidity or mortality.

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Indications

Contraindications

  • The need for emergent thoracotomy is an absolute contraindication to tube thoracostomy.
  • Relative contraindications include the following:
    • Coagulopathy
    • Pulmonary bullae
    • Pulmonary, pleural, or thoracic adhesions
    • Loculated pleural effusion or empyema
    • Skin infection over the chest tube insertion site

More on Tube Thoracostomy

Overview: Tube Thoracostomy
Treatment & Medication: Tube Thoracostomy
Multimedia: Tube Thoracostomy
References
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References

  1. Meredith JW, Hoth JJ. Thoracic trauma: when and how to intervene. Surg Clin North Am. Feb 2007;87(1):95-118, vii. [Medline].

  2. Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. Feb 2007;17(1):1-9. [Medline].

  3. Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma. May 1997;42(5):973-9. [Medline].

  4. Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. Feb 2007;17(1):47-55. [Medline].

  5. Mattox KL, Allen MK. Systematic approach to pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema. Injury. Sep 1986;17(5):309-12. [Medline].

  6. Bailey RC. Complications of tube thoracostomy in trauma. J Accid Emerg Med. Mar 2000;17(2):111-4. [Medline].

  7. Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think?. Emerg Med J. Jan 2005;22(1):8-16. [Medline].

  8. Tsukahara K, Kawabata K, Mitani H, Yoshimoto S, Sugitani I, Yonekawa H, et al. Three cases of bilateral chylothorax developing after neck dissection. Auris Nasus Larynx. Dec 2007;34(4):573-6. [Medline].

  9. Muzumdar H, Arens R. Pleural fluid. Pediatr Rev. Dec 2007;28(12):462-4. [Medline].

  10. Roberts JR, Hedges RJ, eds. Clinical Procedures in Emergency Medicine. 4th. Philadelphia: WB Saunders Company; 2004.

  11. Reichman EF, Simon RR, eds. Emergency Medicine Procedures. 1st. Columbus, OH: McGraw-Hill Professional; 2003.

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Further Reading

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Keywords

tube thoracostomy, chest tube, tube chest, tube drain, pneumothorax, hemothorax, empyema, pleural cavity, hemopneumothorax, hydrothorax, chylothorax, pleural effusion, penetrating chest wall injury, systemic analgesia, midaxillary line, subcutaneous tract, tract dissection, intercostal muscles, pleural space, high-pressure empyema, pleural effusion, hemoperitoneum

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Contributor Information and Disclosures

Author

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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