Chest Tube and Pleurx

Sometimes, people may need a chest tube placed with or without a “pleurodesis” ecause of a “spontaneous pneumothorax” or air space surrounding the lung. This pleurodesis treatment makes the lung “stick up” to chest wall.

A spontaneous pneumothorax, or the sudden collapse of a portion of the lung, may occur without any trauma or injury. The pneumothorax results from the rupture of a blister on the lung, which allows air to leak out. When this condition occurs in an individual without prior history of lung disease, it is known as primary spontaneous pneumothorax. This is most commonly seen in tall, thin individuals between the ages of 17-40 who have a predisposition to spontaneous pneumothorax. The anatomy of their lungs, in addition to the large volume of air they hold makes it more likely that a small blister–a bleb–will burst on the upper part of the lung. The lung collapse is unpredictable, as it may occur during physical
activity or simply at rest.

When the pneumothorax is due to an underlying lung condition such as emphysema, it is known as a secondary spontaneous pneumothorax. In this, the emphysematous blebs are larger and known as bulla.

Sometimes, people may need a chest tube or Pleurx placed for a pleural effusion. A PleurX is like a chest tube except it is smaller and designed for use at home. Your body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the thin tissue that lines the chest cavity and surrounds the lungs. A pleural effusion is an abnormal, excessive collection of this fluid.

Types:

  1. Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by increased pressure in the blood vessels or a low blood protein count. Congestive heart failure is the most common cause.
  2. Exudative effusions are caused by blocked blood vessels or lymph vessels, inflammation, lung injury, and tumors.

Symptoms:

  • Chest pain, usually a sharp pain that is worse with cough or deep breaths
  • Cough
  • Fever
  • Hiccups
  • Rapid breathing
  • Shortness of breath
  • Sometimes there are no symptoms

A “pleurodesis” is treating the pleura (or lung lining) so that the fluid will not build up again or that area of the lung will not “collapse” again. The pleura is “treated” either in the operating room or at the bedside by instilling sterile talc directly into the chest tube to irritate the pleural lining and then attaching the chest tube to low suction for a few days to make sure the pleura “sticks up” to the chest wall.

If you have a PleurX, a pleurodesis is not performed and you go home with the small tube to have it drained by visiting nurses.

After Chest Tube or PleurX Placement

Patients having a chest tube or Pleurx typically stay in the hospital 2-5 days. They have a small tube draining fluid and air from their side. When the tube is removed, the patient can expect to go home. They usually have a PCA for pain which is transitioned to oral pain medications when the tube is removed. Patients start with a clear liquid diet and are advanced to a regular diet if they tolerate clear liquids. Patients are encouraged to be out of bed and walk as much as possible. Some patients who had a chest tube placed for an initial pleural effusion or pneumothorax may need additional procedures.