What are contraindications for tube thoracostomy?

Answer

The need for emergent thoracotomy is an absolute contraindication to tube thoracostomy.

Relative contraindications include the following:

Coagulopathy
Pulmonary bullae
Pulmonary, pleural, or thoracic adhesions
Loculated pleural effusion or empyema
Skin infection over the chest tube insertion site

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Media Gallery

Skin preparation and marking.
Local anesthesia.
Skin incision.
Blunt dissection down to the intercostal muscle.
Further blunt dissection down to the intercostal muscle.
Palpation of the selected intercostal space and the superior margin of its inferior rib.
A closed and locked Kelly clamp is used to enter the chest wall into the pleural cavity. Make sure to guide the clamp over the upper margin of the rib.
Once the Kelly clamp enters the pleural cavity, the clamp should be opened to further enlarge the opening.
A finger is used to palpate the tract and feel for adhesions before insertion of the chest tube.
The proximal end of the chest tube is held with a Kelly clamp that is used to guide the chest tube through the tract. The distal end of the chest tube should always be clamped until it is connected to the drainage device.
Connection of the chest tube to a drainage system.
A 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin.
Apply petrolatum (eg, Vaseline) gauze over the skin incision.
Preparation of a Y-shaped fenestrated drain gauze from regular gauze (4 x 4 in).
Apply support gauze dressing around the chest tube and secure it to the chest wall with 4-in adhesive tape.
The chest tube is angulated, overlying the diaphragm.
A needle and a syringe are used to decompress the pleural cavity in a case of tension empyema.
The safe triangle.
Chest tube in good position.

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Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Nader Kamangar, MD, FACP, FCCP, FCCM Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Medicine, Olive View-UCLA Medical Center

Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: Academy of Persian Physicians, American Academy of Sleep Medicine, American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, Association of Pulmonary and Critical Care Medicine Program Directors, Association of Specialty Professors, California Sleep Society, California Thoracic Society, Clerkship Directors in Internal Medicine, Society of Critical Care Medicine, Trudeau Society of Los Angeles, World Association for Bronchology and Interventional Pulmonology

Disclosure: Nothing to disclose.

Additional Contributors

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.

What are contraindications for tube thoracostomy?

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