Thoracostomy

Overview

During a thoracostomy, a tube is inserted into your chest through an incision (cut) made by the surgeon. The area between the thin membranes (pleurae) that line your chest wall and lungs is known as the pleural space, and a chest tube is used to drain fluid or air from it. A doctor will perform an emergency needle thoracostomy to treat a tension pneumothorax, which is a condition in which air enters your lungs but cannot exit before placing a chest tube.

Reasons for undergoing the procedure

To alleviate the presence of fluid or air within the chest cavity, medical professionals employ a procedure known as thoracostomy. Thoracostomy is utilized as a therapeutic approach for the following medical conditions:

• Empyema: When there is an accumulation of pus within the pleural space.
• Pneumothorax: In cases of a collapsed lung due to the presence of air in the pleural cavity.
• Pleural effusion: When excess fluid collects around the lungs.
• Chylothorax: For addressing the presence of lymphatic fluid within the chest cavity.
• Hemothorax: In situations where blood accumulates within the chest cavity.
• Lung infections.

Risks

Although doctors take every measure to reduce risks, there are always some. Thoracostomy risks include:

• Infection.
• Bleeding.
• Nerve or tissue damage.
• The tube becomes dislodged or misplaced.
• Subcutaneous emphysema, which is the buildup of air beneath the skin.
• Re-expansion pulmonary edema, which is the fluid that surrounds your lung following its reinflation.

Before the procedure

Sometimes a thoracostomy is performed in the middle of an emergency situation, and you are not prepared for it. In other cases, you will receive preparation instructions from your provider. This could consist of:

• Modifying your drug plan in the days preceding the operation.
• Skipping some medications.
• Avoiding food and liquids for a predetermined period of time prior to the procedure.
• Dressing comfortably the day of the operation.

Inform your doctor of the following:

• About all the prescription drugs you take, including any dietary supplements or vitamins.
• If you believe you may be pregnant or are currently pregnant.
• If you are allergic to any drugs.

During the procedure

Before the thoracostomy, your doctor will order an imaging test, such as a chest X-ray, to help them choose where to put the tube. In the course of a tube thoracostomy, your doctor will:

• Position yourself with your head raised and one arm extended beside your head.
• Give your chest’s side a thorough cleaning and sterilization.
• Use a local anesthetic injection to numb the side of your chest (such as lidocaine). After this process, they’ll wait a few minutes to make sure you’re completely numb.
• Create a tiny incision between your two ribs on the side of your chest.
• Attach the hemostat to the opening. (not every thoracostomy involves this step.)
• Place a tube into your chest through the incision. You might attach the tubing to a drainage container.
• Encircle the incision with a sterile bandage.

With a needle thoracostomy, a doctor will:

• Sterilize and clean a section of your upper chest.
• Place a needle between two ribs in your upper chest.
• A tube thoracostomy typically used after a needle thoracostomy.

Typically, a thoracostomy takes half an hour.

After the procedure

A second chest X-ray will be taken by your provider following a thoracostomy. They will also provide you with instructions on how to care for yourself and the chest tube. Among the directions could be the following:

• Maintain a clean and dry skin around the incision site.
• Maintain the drainage container and the tubing. This entails keeping the container below chest level and ensuring the tube doesn’t kink or tangle.
• Take any prescription drugs as directed.

Outcome

Certain chest tubes are only removed when all the fluid has drained. Usually, this is completed in a few days. You might need to have a chest tube in for a longer period of time if fluid continues returning due to a persistent ailment. Find out what to expect from your doctor.

It could require three to four weeks for the incision to fully heal after a doctor removes your chest tube. You will receive instructions from your doctor on how to take care of the incision site and whether you should avoid doing certain things while it heals.