Intercostal Drainage

CHEST TUBE DRAINAGE

Chest tube insertion is a critical procedure used in children to treat conditions such as pleural effusion, empyema, and other conditions where fluid accumulates around the lung. It involves the placement of a tube into the pleural space (the cavity between the lung and the chest wall) to drain air, fluid, or pus, helping the lung to re-expand and function normally. This procedure is particularly important in pediatric care, as conditions like empyema in children and pleural effusion in children can occur as a complication of pneumonia and cause significant respiratory distress and require immediate medical intervention.

What Is Chest Tube Insertion?

Chest tube insertion, also known as intercostal drainage, involves placing a flexible tube through the chest wall into the pleural space to remove air, fluid, or pus. The tube helps restore normal lung function by preventing the accumulation of substances that might compress the lung and interfere with breathing.

Common reasons for performing chest tube insertion in children include:

Pleural effusion in children: The buildup of fluid in the pleural cavity, which can result from infections, trauma, or other medical conditions.

Empyema in children: Infection in the pleural space, often caused by pneumonia, leading to the accumulation of pus.

Pneumothorax: Air trapped between the lung and chest wall, often caused by trauma or lung disease.

Hemothorax: Blood in the pleural space due to injury or surgery.

Frequently Asked Questions

1. Why is chest tube drainage necessary for pleural effusion in children?

Chest tube drainage is often required when there is a pleural effusion in children, which is the accumulation of excess fluid in the pleural space. This condition can cause difficulty breathing, chest pain, and decreased lung function. The chest tube helps remove the fluid, relieving pressure on the lung and allowing it to expand fully. In cases where the pleural effusion is due to an infection (such as empyema), the chest tube also helps drain pus and prevent further complications.

2. What is empyema in children, and how is it treated with chest tube insertion?

Empyema in children is a severe infection in the pleural space, typically caused by pneumonia. As the infection progresses, pus accumulates in the pleural cavity, which can obstruct the lung's ability to expand and lead to respiratory distress. Chest tube insertion is an effective treatment to drain the pus and help the lung re-expand. The procedure is often followed by antibiotics to treat the underlying infection, ensuring that the child recovers fully.

3. How is chest tube drainage performed in children?

Chest tube drainage, also known as intercostal drainage, is typically done under local anesthesia with sedation. A small incision is made between the ribs, and a flexible tube is inserted into the pleural space to drain air, fluid, or pus. The tube is usually connected to a drainage system that collects the fluid. The procedure is performed under strict sterile conditions to minimize the risk of infection. The child will be closely monitored after the procedure to ensure proper drainage and to check for complications.

4. How much time does it take to drain pleural fluid?

Pleural effusion usually drains out in 3-4 days, however empyema may take longer as pus is thicker and difficult to drain. Sometimes, we may need to instill some medicines into the chest drain to liquefy the pus for easy drainage. In that case it may take upto 7 days for complete drainage. Your doctor evaluates clinically and with the help of radiological tests determines pleural fluid.

5. Are there risks or complications associated with chest tube drainage in children?

While chest tube drainage is generally a safe procedure, there are some potential risks and complications, including:

Infection: Though sterile techniques are used, there is always a risk of infection at the insertion site or within the pleural cavity.

Bleeding: Insertion of the chest tube can cause injury to blood vessels, leading to bleeding.

Pneumothorax: In rare cases, the procedure may inadvertently cause air to enter the pleural space, leading to a collapsed lung.

Tube displacement: The tube may become dislodged or blocked, which can affect the effectiveness of the drainage.

Pain: While the procedure is done under local anesthesia, some discomfort may be experienced post-procedure.

The medical team will closely monitor the child for any complications and provide appropriate treatment if needed.