Are you afraid of having a chest tube (Thoracostomy) inserted? Let's learn about it simply!

Have you ever seen someone with a tube stuck in their chest? Maybe on TV, in a movie, or even in a real hospital. It can be a scary and uncomfortable sight to see. "Why are they doing this? This must hurt a lot, right?" You might think. But did you know that putting a tube in your chest is a very important medical procedure that is often done to save someone's life? Today, we're going to talk about this procedure, which is called a thoracostomy in medicine, in a very simple way that you can understand.

Simply put, what is Thoracostomy?

A thoracostomy is a procedure in which a surgeon makes a small incision in the side of your chest and inserts a tube into your chest. This tube is commonly called a chest tube. The main reason for doing this is to drain any excess air, fluid, blood, or pus that has accumulated in the space around your lungs (which we medically call the pleural space).

Think of our lungs as two balloons. These two balloons are inside the chest cavity. There is a very small space between the lungs and the inner wall of the chest cavity. Normally, there is nothing in this space. But due to some diseases or when there is an accident, this space fills with things like air and water. Then the lungs become compressed and cannot inflate properly. It becomes difficult to breathe, and there is chest pain. That's when doctors insert a chest tube to remove this accumulated stuff.

In some emergencies, especially tension pneumothorax, a needle thoracostomy is performed to relieve the pressure by releasing the trapped air before a chest tube is inserted. This is done in an emergency setting, such as in the Emergency Department (ETU), to save the patient's life.

What conditions is this treatment used for?

There are many reasons why a thoracostomy may be performed. It is mainly used in cases where there is an accumulation of unwanted material around the lungs. Let's take a look at some of these situations.

How should you prepare for this?

This is a very important question. But the answer is a little complicated. Because most of the time, this procedure called Thoracostomy is done in an emergency. Imagine that someone has been in a car accident on the road and is rushed to the hospital's Emergency Treatment Unit (ETU). If his lungs are damaged and he is inflated, the doctors have to quickly insert a chest tube to save his life. In such a situation, there is no time to prepare.

But sometimes, due to a pre-existing medical condition (for example, someone with persistent fluid around the lungs), this can be planned in advance. In such cases, your doctor will give you instructions on how to prepare. These instructions may include:

• You may be asked to stop taking certain medications (especially blood thinners) a few days before treatment.
• You may be asked to change the timing of your medication.
• You will be asked to refrain from eating or drinking for a few hours before the treatment.
• You may be asked to wear comfortable, loose clothing.

What actually happens during treatment?

Okay, now let's see how to do this. Don't be afraid to read this. This is done as painlessly and safely as possible.

First, the doctor will do a chest X-ray or other scan to find the exact location where the tube should be inserted. Then the treatment will begin.

1. Positioning: You will be asked to lie down on the bed, with your head slightly elevated, and the arm on the side where the tube will be inserted will be placed above your head. This will open up the space between your ribs, making it easier to insert the tube.

2. Cleaning: Next, the area of ​​the chest chosen for the tube is thoroughly cleaned with an antiseptic solution. This is done to prevent any germs from entering the body.

3. Numbness: Now is the most important part. To prevent you from feeling any pain, a local anesthetic , such as Lidocaine , is injected into the area. You may feel a slight stinging sensation when the injection is given, but within a few minutes the entire area will be completely numb. So you won't feel anything after that.

4. Making the incision: Now that you are numb, the doctor will make a very small incision between two of your ribs. This is not a large incision, just enough to insert the tube.

5. Insertion of the tube: Next, the chest tube is carefully inserted through the incision into the space around the lungs. The other end of this tube is connected to something like a water bottle (drainage container). The air and water in the chest will flow through this tube and collect in that bottle.

6. Protection: Finally, a sterile dressing is placed around the insertion site and covered. Sometimes, a small stitch may be placed on the skin to secure the tube to the skin to prevent it from moving around.

This entire process usually takes about 30 minutes .

What happens after treatment?

After the tube is inserted, you will have another chest X-ray to make sure it is in place and that your lungs are inflated properly. Then the doctor and nurses will give you instructions on how to care for the tube.

• The incision site should be kept clean and dry .
• It gives instructions on how to care for the tube and the bottle connected to it (drainage container). The most important thing is not to let the tube get bent or stuck anywhere . Also, the bottle should always be kept below chest level . That way, the contents of the chest will flow easily into the bottle according to gravity.
• You need to take the prescribed medications exactly on time .

What are the benefits of this treatment?

Although this may seem a little scary, it has many advantages.

• This is not a major surgery (Minimally invasive): Since it is performed through a small incision, rather than a large incision, there is less damage to the body and the healing process is faster.
• Can save lives in emergencies: This can quickly save a life in the event of an accident or lung collapse. It can also provide relief from long-term conditions.
• No need to put the patient completely to sleep: This is often done under anesthesia, so there is no risk of major anesthesia.
• Quick relief for shortness of breath: A person who is having difficulty breathing due to fluid filling their lungs will feel great relief immediately after doing this.

Are there any side effects or risks?

As with any medical treatment, there are some very small risks involved, but doctors take every possible step to minimize these risks.

• The tube is inserted in the wrong place or moves from its original position.
• Infection at the incision site.
• Subcutaneous emphysema (air accumulation under the skin).
• Re-expansion pulmonary edema (fluid filling around a deflated lung after it suddenly expands again).
• Bleeding.
• Minor damage to nerves or surrounding tissue.

The chances of these things happening are very low. But it's good to be aware of things like this. If you have any questions, ask your doctor.

How long should the tube be left in? How long does it take to heal?

The length of time a chest tube is in place depends on the reason for its placement.

• If a small amount of blood or air was removed after an accident, the tube can be removed in a few days after it has completely drained.
• However, if the fluid continues to fill up due to a long-term condition, you may need to have the tube in place for several weeks . Your doctor will explain this to you.

After the tube is removed, it can take three to four weeks for the incision to fully heal. During that time, your doctor will advise you on how to care for the wound and whether you should avoid strenuous activities.

If you see anything like this, tell your doctor immediately.

If you have a chest tube, watch out for the following symptoms. If you have any of these, tell your doctor immediately .

What is the difference between Thoracostomy, Thoracentesis, and Thoracotomy?

These three words sound similar, but they are three different treatments. Many people get confused between them. Let's see what the difference is.

Simply put, a thoracotomy is a major operation. After that operation, a thoracostomy (chest tube) may be placed to remove fluid that accumulates in the chest.