Thoracostomy tubes

Thoracostomy tubes are used to drain fluid, empyemas, blood, and pneumothoraces. Tubes placed for pneumothorax drainage in supine patients work best when placed anterosuperiorly, whereas fluid collections drain best when placed posteroinferiorly. Small-bore chest tubes may be placed with radiographic guidance and are increasingly used to drain small or loculated pneumothoraces. Complications of thoracostomy tubes include injury to the mediastinal vessels or nerves, subcutaneous emphysema (particularly if the side-port is not within the rib cage), contusion of the underlying lung, and malfunction of the tube due to malposition either in a fissure or with the tube in an extrapleural location. After tube removal, a tube track is commonly seen at the site of the placement and should not be confused with a residual pneumothorax. A radiograph should be obtained immediately after thoracostomy tube placement, both to verify the location of the tube and to assess its therapeutic efficacy. Routine follow-up radiographs are not warranted ( Henschkeefa/ 1996).

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