Overview
Pediatric Chest Tube Insertion is a procedure used to drain air or fluid from the pleural space. This procedure is commonly performed for pneumothorax, pleural effusion, hemothorax, and other thoracic conditions in children.
Chest tube insertion is essential for managing life-threatening thoracic conditions in pediatric patients. Proper technique is crucial to avoid complications and ensure effective drainage. This procedure can be life-saving in emergency situations.
Learn more in our comprehensive RxDx Pediatrics Course
Indications
Air in pleural space causing respiratory compromise
Fluid accumulation in pleural space
Blood accumulation in pleural space
Infected pleural fluid requiring drainage
Following thoracic surgery
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes explaining the procedure to patient and family, selecting appropriate tube size, gathering necessary equipment, ensuring proper patient positioning, and preparing for potential complications. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure to patient and family. Position patient appropriately. Administer sedation and analgesia. Prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Poor positioning
- Insufficient analgesia
💡 Pro Tip:
Use age-appropriate language and involve parents in the process.
Step 2: Site Selection
Select appropriate site (4th-5th intercostal space, mid-axillary line). Mark site. Clean area with antiseptic solution.
⚠️ Common Mistakes to Avoid:
- Poor site selection
- Insufficient cleaning
- Wrong intercostal space
💡 Pro Tip:
Use the 4th-5th intercostal space in the mid-axillary line for most cases.
Step 3: Local Anesthesia
Administer local anesthetic to skin, subcutaneous tissue, and intercostal space. Wait for effect. Test sensation.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong anesthetic dose
- Insufficient wait time
💡 Pro Tip:
Use adequate local anesthetic to minimize patient discomfort.
Step 4: Skin Incision
Make skin incision 1-2 cm in length. Bluntly dissect through subcutaneous tissue to intercostal space.
⚠️ Common Mistakes to Avoid:
- Inadequate incision
- Poor dissection
- Wrong technique
💡 Pro Tip:
Use blunt dissection to avoid injury to underlying structures.
Step 5: Pleural Entry
Enter pleural space above rib to avoid neurovascular bundle. Insert finger to confirm placement. Dilate tract.
⚠️ Common Mistakes to Avoid:
- Wrong entry point
- Injury to neurovascular bundle
- Poor tract dilation
💡 Pro Tip:
Enter the pleural space above the rib to avoid the neurovascular bundle.
Step 6: Tube Insertion
Insert chest tube through tract. Advance to appropriate depth. Connect to drainage system. Secure tube.
⚠️ Common Mistakes to Avoid:
- Wrong tube depth
- Poor connection
- Inadequate securing
💡 Pro Tip:
Advance the tube posteriorly and superiorly for optimal drainage.
Master Pediatric Chest Tube with RxDx
Access 100+ procedure videos and expert guidance with the RxDx app
Post-procedure Care
Post-insertion care involves confirming proper placement with imaging, connecting to drainage system, monitoring for complications, and documenting the procedure. Regular assessment of tube function is essential.Complications & Management
Complication | Incidence | Signs | Management | Prevention |
---|---|---|---|---|
Infection | 5-15% | Redness, warmth, pain at site, fever | Antibiotics, tube removal if needed | Strict aseptic technique |
Bleeding | 5-10% | Blood in drainage, hypotension | Surgical consultation, blood products | Proper technique, coagulation check |
Tube dislodgement | 5-15% | Poor drainage, air leak | Reposition or replace tube | Proper securing, monitoring |
Subcutaneous emphysema | 10-20% | Crepitus, swelling | Monitor, adjust tube if needed | Proper technique, adequate tube size |
Clinical Pearls
Use age-appropriate language and involve parents in the process.
Use the 4th-5th intercostal space in the mid-axillary line for most cases.
Use adequate local anesthetic to minimize patient discomfort.
Enter the pleural space above the rib to avoid the neurovascular bundle.
Advance the tube posteriorly and superiorly for optimal drainage.
Use blunt dissection to avoid injury to underlying structures.
Always confirm pleural entry with finger before inserting tube.