Chest Tube Insertion

Pemasangan Thorax Tube

Aida Yulia Amany

Thoracic Cavity

Batas – batas cavitasthorax• Anterior = sternum• Posterior = vertebra

thorakal• Lateral = ribs• Inferior = diafragma

Thoracic Cavity

• Right lung• Left lung• Mediastinum

HeartAorta & great vesselsEsofagusTrachea

Breathing : Inspirasi

• Diafragma berkontraksi, vol cav thorax ↑, tekanan intrapulmoner ↓

• Udara dari luar memiliki tekanan lebih tinggi masuk ke paru yang tekanannya lebih rendah

Breathing : Ekspirasi

• Diafragma relaksasi, vol cav thorax ↓ tekanan intrapulmoner ↑

• Udara mengalir keluar dari paru menuju ke luar yang tekanannya lebih rendah

Pleural Anatomy

Paru – paru dilapisi oleh pleura• Parietal pleura : melapisi dinding dada• Visceral pleura : melapisi paru ˗ paru• Ruang diantara kedua pleura disebut spatium

pleura atau cavum pleura

Thorax Tube

• Tube thoracostomy, thoracic catheter, chest drain, intercostal drain

• “Adalah sebuah selang elastis yang dimasukkan pada cavum pleura melalui dinding dada untuk mengeluarkan udara, darah, pus, dan cairan lainnya”

Indikasi pemasangan thorax tube

PneumothoraxUdara pada cavum pleura


HemothoraxDarah pada cavum pleura


Pleural effusionTransudat / eksudat padacavum pleura

Kontraindikasi Pemasangan Thorax Tube

• Infeksi pada lokasi pemasangan• Gangguan pembekuan darah yang tak terkontrol

Equipment• Chest tube drainage device with

water seal• Suction source and tubing• Sterile gloves• Preparatory solution• Sterile drapes• Surgical marker• Lidocaine 1% with epinephrine• Syringes, 10-20 mL (2)• Needle, 25 gauge (ga), 5/8 in• Needle, 23 ga, 1.5 in; or 27 ga, 1.5

in; for instilling local anesthesia• Blade, No. 10, on a handle• Large and medium Kelly clamps

• Large curved Mayo scissors• Large straight suture scissors• Silk or nylon suture, 0 or 1-0• Needle driver• Vaseline gauze• Gauze squares, 4 x 4 in (10)• Sterile adhesive tape, 4 in wide• Chest tube of appropriate size

Man - 28-32FWoman - 28FChild - 12-28FInfant - 12-16FNeonate - 10-12F

Equipment

Memposisikan Pasien

• Posisikan pasien dalam keadaan supine atau 45o

• Abduksikan lengan dan rotasikan eksternal lalu letakkan telapak tangan di belakang kepala

Langkah Pemasangan Thorax Tube

Skin preparation and marking.The skin incision is made in between the midaxillary and anterior axillary lines over a rib that is below the intercostal level selected for chest tube insertion.


Administer local anasthesia


Skin incission approximately 4 cm long Should be in the same direction as the rib itself


Blunt dissection using Kelly clamp down to intercostal muscle


Palpation of the selected intercostal space and the superior margin of its inferior rib

Langkah Pemasangan Thorax TubeA closed and locked Kelly clamp is used to enter the chest wall into the pleural cavity. Make sure to guide the clamp over the upper margin of the rib.

Once the Kelly clamp enters the pleural cavity, the clamp should be opened to further enlarge the opening.


A finger is used to palpate the tract and feel for adhesions before insertion of the chest tube.


The proximal end of the chest tube is held with a Kelly clamp that is used to guide the chest tube through the tract.

The distal end of the chest tube should always be clamped until it is connected to the drainage device.


A 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin.

Apply petrolatum (eg, Vaseline) gauze over the skin incision.


Apply support gauze dressing around the chest tube and secure it to the chest wall with 4-in adhesive tape

Chest tube in good position.

Thorax Drainage System

“Bagaimana cara kerja sistem drainase?”


• Hanya bisa digunakan untuk pneumothoraxTube open to

atmosphere vents air Tube from patient


• The first bottle collects the drainage

• The second bottle is the water seal

• With an extra bottle for drainage, the water seal will then remain at 2cm

Tube open to atmosphere vents air

Tube from patient


Fluid drain

Tube from patient

Tube open to atmosphere vent air

Tube to vacuum source

Straw under 20cm H20


• Keep drain below the chest for gravity drainage

• Fluid, like air, moves from an area of higher pressure to an area of lower pressure

Komplikasi Pemasangan Thorax Tube

• Improper placement• Perdarahan• Hemoperitoneum

liver atau splen injury, segera laparotomy emergency

• Penetrasi organbiasanya membutuhkan repair surgery

Komplikasi Pemasangan Thorax Tube

• Tube dislodgement• Empyema

chest tube bisa mengakibatkan masuknya bakteri ke cavum pleura

• Retained pneumothorax atau hemothorax

Reference

• Gil Z Shlamovitz. 2014.Tube Thoracostomy. Diakses dari http://emedicine.medscape.com/article/80678

• Queens university. 2012. Tube Thoracostomy. Queens University : Dept. Of Emergency Medicine

• American Thoracic Society. 2013. Chest Tube Thoracostomy. Respir Crit Care Med Vol. 170

http://emedicine.medscape.com/article/80678

Chest Tube Insertion

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