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An intrapleural chest tube is also known as a Bülau drain or an intercostal catheter (ICC), and can either be a thin, flexible silicone tube (known as a "pigtail" drain), or a larger, semi-rigid, fenestrated plastic tube, which often involves a flutter valve or underwater seal.
Chemicals such as bleomycin, tetracycline (e.g., minocycline), [2] povidone-iodine, or a slurry of talc can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating. [3]
External suction (previously referred to as active suction) is used to create a sub-atmospheric pressure at the tip of a catheter.As the atmospheric pressure is lower compared to the intrapleural pressure, the lack of external suction (which was previously referred to as passive suction) is used to drain air and fluids. [1]
Chest tubes are usually removed one week after surgery along with any stitches or staples in the incisions. Patients experiencing shortness of breath will be guided through deep breathing or coughing exercises by a physician or respiratory therapist. In severe cases, the patient will also receive oxygen supplementation through a mask or nostril ...
This is a surgical procedure that involves inserting a chest tube, then either mechanically abrading the pleura or inserting the chemicals to induce a scar. This requires the chest tube to stay in until the fluid drainage stops. This can take days to weeks and can require prolonged hospitalizations.
Medical procedures, such as inserting a central venous catheter into one of the chest veins or taking biopsy samples from lung tissue, may also lead to pneumothorax. The administration of positive pressure ventilation , either mechanical ventilation or non-invasive ventilation , can result in barotrauma (pressure-related injury) leading to a ...
The flap allows for 1) passive drainage of the pleural space and 2) negative pressure to develop in the thoracic cavity due to it being easier for air to escape than to enter the chest. The lung can then expand to the chest wall and seal the inner opening of the flap. [3] Other surgeons have subsequently proposed modifications to the procedure. [6]
Thoracostomy tubes with a diameter of 24–36 F (large-bore tubes) should be used, as these reduce the risk of blood clots obstructing the tube. Manual manipulation of chest tubes (referred to as milking, stripping, or tapping) is commonly performed to maintain an open tube, but no conclusive evidence has demonstrated that this improves ...