Chest drainage

Chest drainage refers to the process of removing air, blood, pus, or other fluids from the pleural space or mediastinum—the areas surrounding the lungs and heart—to restore normal respiratory function and reduce discomfort. This medical procedure is essential in treating conditions such as pneumothorax (air in the chest cavity), hemothorax (blood in the chest cavity), pleural effusion (fluid in the chest cavity), and empyema (pus in the chest cavity). Chest drainage is performed using a chest tube (thoracostomy tube) and a drainage system, which may be gravity-based or use a suction mechanism to help remove the fluid or air.

Indications

Chest drainage is indicated in several conditions, including:

• Pneumothorax, especially tension pneumothorax, where air trapped in the pleural space causes significant pressure on the lungs and heart.
• Hemothorax, where blood accumulates in the pleural space, often due to trauma.
• Pleural effusion, where excess fluid builds up in the pleural space, which can be symptomatic of infection, malignancy, or other diseases.
• Empyema, an accumulation of pus in the pleural space, usually due to an infection.
• Postoperative management after thoracic surgery to prevent fluid accumulation and facilitate lung expansion.

Procedure

The chest drainage procedure involves the insertion of a chest tube into the pleural space. This is typically done under sterile conditions in a hospital setting. The process includes:

• Local anesthesia is administered to the site where the chest tube will be inserted.
• A small incision is made on the chest wall, and a blunt dissection is performed to reach the pleural space.
• The chest tube is inserted through the incision into the pleural space, directed towards the area of fluid or air accumulation.
• The tube is then connected to a drainage system, which may operate on gravity or suction, to remove the unwanted substance from the chest cavity.
• The tube is secured in place, and the system is monitored for proper function.

Complications

While chest drainage is a common and generally safe procedure, complications can occur, including:

• Infection at the insertion site or within the pleural space.
• Injury to surrounding structures, such as the lungs, heart, or diaphragm.
• Re-expansion pulmonary edema, a rare but serious condition that can occur if the lung re-expands too quickly after being collapsed.
• Subcutaneous emphysema, where air leaks into the tissues under the skin.

Aftercare

Proper aftercare is crucial for recovery and includes monitoring the drainage system, ensuring the chest tube remains in place and functional, and watching for signs of infection or other complications. The chest tube is removed once imaging confirms that the underlying issue has been resolved and no further drainage is needed.