GA with chest tube

[jsckvc]

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so for you seasoned docs out there. other than low peak pressures and low peep what are the the main concerns for a GA with a chest tube in place with c-xray conformation of resolution of PTX. cant find much on the subject and is first case in AM.

thanks

 

[proman]

Make sure the ETT is in the trachea. If it's not a bronchopleural fistula there shouldn't be much to worry about. What's the case? Why was there a pneumo?

 

[jennyboo]

so for you seasoned docs out there. other than low peak pressures and low peep what are the the main concerns for a GA with a chest tube in place with c-xray conformation of resolution of PTX. cant find much on the subject and is first case in AM.

thanks

Try not to rip out the chest tube while moving the patient. 😀

 

[rsgillmd]

As above.

Also keep an eye on the chest tube. Blood filling a chest tube = bad.

I had a case as a resident during my SICU rotation where a patient with a newly inserted chest tube (I forget the reason) was hypotensive, tachycardic, and seemed to be worsening. As I'm trying to figure out why, I looked at the chest tube. It had more blood in it than before. Ended up taking the patient to the OR. The ER doc that put the chest tube hit a vessel in the lung somehow. The patient ended up getting a wedge resection.

Generally chest tubes with no residual pneumo are no big deal as long as you don't pull them out or kink them.

 

[deleted126335]

If you are doing a pneumonectomy and the surgeon chooses to place a chest tube, Don't put the chest tube to suction on arrival to ICU. Make sure the ICU nurses know this.

 

[wine thief]

If you are doing a pneumonectomy and the surgeon chooses to place a chest tube, Don't put the chest tube to suction on arrival to ICU. Make sure the ICU nurses know this.

Great point. Most of our thoracic guys don't even place them after pneumonectomy for exactly that reason. The pleurovac is a simple 3 chamber system, yet remains a mystery to many. I've seen them mistakenly clamped, seen them with NO water seal (nurse forgot to add it), or found them completely full (SICU nurse told me I could change it myself, clearly zero understanding of why that was bad. She was in the middle of an important sudoku, however).