Chest Tube and PleurX Placement

Chest tube placement is a minimally-invasive procedure (small incisions of 2–3 inches long / local anesthesia) performed to treat and prevent pleural effusions. Pleural effusion is a condition that causes excess fluid buildup in the lungs, specifically the pleura. The pleura is a thin membrane covering the surface of the lungs and chest wall. Some fluid is always found here, but the amount should be no more than a few teaspoons. Pleural effusion does not always cause problems, but severe cases can result in inflammation and difficulty breathing.

Chest tube placement involves the insertion of a thin plastic tube into the pleural space. The tube may be attached to a suction device to remove excess fluid or air. Or, it may be used in a procedure called pleurodesis in which medication is delivered into the space to decrease the likelihood that fluid will accumulate.

A PleurX is like a chest tube except it is smaller and designed for use at home.

Do you need a chest tube?

To determine whether you need a chest tube, your doctor might perform a variety of tests, including:

How to prepare for placement of a chest tube

Prior to the procedure to insert a chest tube, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about:

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Radiation exposure, especially for those who are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any body piercings on your chest or abdomen

Checklist of things to do before chest tube placement

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home.
  • Remove all makeup and nail polish.
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect during chest tube or PleurX placement

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A chest tube placement procedure will typically take between 15 to 30 minutes to complete. This procedure is typically performed bedside and occasionally in the operating room. Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your arm which will administer medications, fluids and a sedative.
  • Your doctor will use a local anesthetic to numb the area of your chest where the incision will be made.
  • The doctor will make a small incision and insert a chest tube. Then the fluid will be drained into a collection device.
  • Once the fluid has been drained, the doctor may perform a pleurodesis— 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 — talc powder, doxycycline, or another medicine may be injected into the pleural space through the chest tube. The medicine will coat the outside of your lung and create a sticky surface that makes it adhere 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.
  • Your doctor might do an X-ray to confirm that the procedure was successful.
  • When the chest tube is no longer needed, your doctor will loosen the suture or tape, you will take a deep breath and the tube will be removed. The area may be sutured and a special bandage applied.

What to expect after chest tube placement

After a chest tube placement, you will be taken to the recovery room for one to two days. You may be given antibiotics and pain medication, including long-acting oral pain medication, NSAIDS, IV pain medication and multi-level intercostal nerve blocks.

Your doctor will give you instructions to follow during your recovery.

Recommendations for post-operative care include:

  • Change positions often while lying down, and exercise if possible.
  • Keep the skin around where the chest tube is inserted clean and dry.
  • Take regular deep breaths followed by a cough.
  • Maintain the drainage system as instructed, keeping it below chest level.

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