[Essence of perioperative chest tube management]

Abstract

Physicians are required to be familiar with the basic theory of chest drainage to take care of the patients with chest diseases. This short review deals with management of the chest drainage tube including perioperative period. The indications for chest drainage are pneumothorax, pleural effusion, hemothorax, empyema, postoperative care after thoracotomy. When inserting the drainage tube, the position of the patient depends on the disease and condition. Aspiration of the pleural effusion through bronchofistura should be avoided. Injury of the intercostal vessels should also be avoided. A 3-bottle system is commonly adopted for the drainage system. Although continuous suction with negative pressure is commonly applied, several studies suggest that suction is not always required as far as the water seal is secure, and recommend the indication of suction only when air leakage persists or when sufficient expansion of the lung is not obtained. The checkpoint of bedside management of chest drainage includes flexure, torsion, disconnection and obstruction of the tube, and also the site of the side holes of the tube etc. The complications of chest drainage are infection, subcutaneous emphysema, pain, re-expansion pulmonary edema etc. Indications of removing the drainage tube are generally full-expansion of the lung, no air leakage, no hemorrhage and decrease of the pleural effusion, but the detailed criteria differ from institute to institute. Establishment of the standard management method of chest drainage is desired.