Let's learn about placing a tube in the chest (Thoracostomy) in a simple way.

Have you ever heard of someone having a chest tube inserted after an accident or because they were having trouble breathing? You may have even seen it in a movie. The medical term for this is Thoracostomy. While it may sound a bit scary, it is a very important life-saving procedure. Okay, so let's talk about it all in simple terms today.

What is Thoracostomy?

Simply put, a thoracostomy is a procedure in which a doctor makes a small incision on the side of your chest, between two ribs, and inserts a plastic tube through it. We usually call this tube a 'chest tube'.

Now look, there are two thin membranes that surround our lungs and line the inside of our chest wall. The space between these two membranes is called the `pleural space`. Due to certain medical conditions or accidents , air, fluid (like water), blood, or pus can accumulate in this space. When this happens, the lungs cannot inflate or deflate properly, which can cause difficulty breathing and severe pain.

In an emergency, especially in a dangerous condition like `Tension Pneumothorax`, where you can breathe in but can't breathe out, doctors quickly insert a needle and let some air out before inserting this chest tube. This is called `Needle Thoracostomy`. This is a life-saving procedure performed in the Emergency Department (ETU).

What conditions is a thoracostomy performed for?

Doctors perform this treatment for various reasons. Let's look at the main reasons.

Do I need to prepare for this treatment beforehand?

Most of the time, this is done in the event of an accident or an emergency, so there is no time to prepare in advance. In such cases, doctors in the Emergency Treatment Unit (ETU) make decisions quickly and do this.

However, sometimes, due to a chronic condition such as persistent fluid in the chest, this tube may be planned and placed. In such cases, your doctor will give you some instructions.

• Some medications (especially blood thinners) may need to be stopped a few days before treatment.
• You will be asked to avoid eating or drinking for a few hours before the treatment.
• Tell your doctor about any other medications, vitamins, or supplements you are taking.
• If you have any allergies to any medication, be sure to mention it.
• Also inform your doctor if you are pregnant or may become pregnant .

What actually happens when a thoracostomy is performed?

This procedure usually takes about 30 minutes. You are awake during this procedure. Don't worry, the doctors will do everything they can to make sure you don't feel any pain.

1. First, a chest X-ray is performed to ensure the correct placement of the tube.

2. Then you will be asked to lie down on the bed, raise your head slightly, and place the arm on the side where the tube will be inserted above your head.

3. The skin on the chest where the tube will be inserted is thoroughly cleaned and washed with an antiseptic solution.

4. Next, the most important thing. A numbing medicine (like `Lidocaine`) is injected into the area of ​​skin. This will help you not feel much pain from what you are doing afterwards.

5. After the skin is numb, a very small incision is made between two ribs.

6. Through that incision, a plastic tube (chest tube) is carefully inserted into the space around the lungs.

7. The outer end of the tube is connected to a special bottle or bag (drainage container) that collects fluid or air coming out of the chest.

8. Finally, an antiseptic ointment is applied to the area where the tube enters the skin and covered with a clean dressing.

What are the benefits and risks of this treatment?

As with any treatment, there are both benefits and very small risks.

Main advantages

• This is a simple procedure that does not require a large incision (minimally invasive).
• It is essential to save lives in emergencies.
• This does not require complete anesthesia (loss of consciousness).
• This provides great relief to someone who has difficulty breathing due to continuous fluid in their chest.

Possible minor complications

Doctors are doing their best to minimize these risks.

• The tube is misplaced or comes loose.
• Wound infection.
• Air accumulation under the skin (`Subcutaneous emphysema`).
• Bleeding.
• Very rarely, damage to nerves or surrounding tissues.
• Fluid builds up around the lungs after they have been re-inflated (`Re-expansion pulmonary edema`).

What happens after treatment?

After the tube is inserted, another X-ray will be taken to make sure it is in place. The doctor and nursing staff will then give you instructions on how to care for the tube and wound while you are in the ward.

• The wound should be kept clean and dry .
• The tube must be kept from bending or getting stuck .
• Most importantly: Always keep the drainage container below your chest level . Otherwise, the contents of the container can leak back into your chest.
• Take painkillers and other medications prescribed by your doctor exactly on time.

How long should a chest tube be left in?

This depends on the reason the tube was inserted. Once all the fluid or air in the chest has drained, the tube is usually removed within a few days. However, if the fluid continues to build up due to a chronic condition, such as cancer, the tube may need to be left in for weeks. Ask your doctor for more information.

When do you need to see a doctor as soon as possible?

If you have a chest tube inserted, be very careful of the following symptoms. If you have any of these, tell your doctor or nurse immediately.

If you see something like this, notify the hospital doctor or nurse immediately. Never be afraid to ask about it.

Thoracostomy, chest tube, chest drain, chest tube placement, pneumothorax, pleural effusion, surgery