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.

Indications

Pneumothorax

Air in pleural space causing respiratory compromise

Pleural Effusion

Fluid accumulation in pleural space

Hemothorax

Blood accumulation in pleural space

Empyema

Infected pleural fluid requiring drainage

Post-operative Drainage

Following thoracic surgery

Contraindications

Absolute Contraindications

Patient or family refusal
Severe coagulopathy
Infection at insertion site

Relative Contraindications

Mild pneumothorax without respiratory compromise
Limited experience with procedure
Severe underlying disease

📋 Equipment Checklist

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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.

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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.