After placement of a chest tube for a pneumothorax

After placement of a chest tube for a pneumothorax, the following chest x-ray is obtained 12 hours later. You are asked to evaluate the patient after reviewing the CXR. After checking the drainage and chest tube site, which of the following is not usually done?

a. Increase level of suction

b. Insert a second chest tube

c. Pull tube back

d. Flush tube with saline to check for patency

e. Check suction machine on the wall

f. Replace drainage kit

  1. The CXR reveals significant sub Q emphysema indicating that there is malfunction of the chest tube.

  2. The first thing to check is patient hemodynamic stability and then patency of the chest tube.

  3. Once a chest tube is inserted, two things should NOT be done

  4. One- never push the chest tube further inside as now you have inserted a non-sterile tube into a sterile chest cavity-instead place a 2nd chest tube is needed

  5. Never flush a tube with saline as this breaks the sterility of the set up and you risk causing an empyema. Instead insert a new chest tube if needed