What is Thoracotomy and Chest Drainage?
The lungs are surrounded by two thin layers of tissue called pleura, which are separated by a thin cavity of fluid called the pleural fluid. The fluid lubricates and helps in the smooth movement of the layers while the lungs expand and contract during breathing. Extra fluid, such as blood, or air in the pleural cavity can cause the collapse of the lungs and disrupt their normal function. This condition is called pleural effusion. Pleural effusion may be caused due to diseases such as pneumonia or cancer, severe injuries to the chest wall, which may cause bleeding, or accidental puncturing of the lungs, which causes accumulation of air outside the lung space.
Chest tubes are inserted into this space to drain out any fluids or air, and allow the lungs to expand completely. This procedure is performed through thoracotomy, a surgical incision made to open the chest wall.
Procedure of Thoracotomy and Chest Drainage
During the process of thoracotomy, you will be under local, spinal or general anesthesia. Your surgeon makes an incision of 1 inch at the side of your chest. A hollow tube is then inserted between the ribs and placed in the pleural space. An X-ray is taken to ensure the correct placement of the tube. X-ray imaging may also be used to direct the tube into the correct location.
The tube is connected to a bottle or canister, which is placed below the chest to allow gravity drainage. Sometimes, the tube may be attached to a suction machine, which helps to drain the extra fluid or air. A one-way valve prevents the backflow of fluid into the lung space. Once the tube is placed your doctor places a stitch (suture) and tape over the skin to prevent it from moving.
Post-procedure Care for Thoracotomy
You will have to stay in the hospital until the excess fluid is drained. You will be closely monitored for air leaks and breathing problems during the drainage process. You may be given oxygen if needed. You will be encouraged to breathe deeply and cough frequently, to help your lungs to re-expand, help with the drainage and avoid fluid collection in your lungs.
After the procedure, you will be monitored closely for your vitals and you may be given pain relief medications. The chest tube is placed temporarily until all the fluid is drained. Once the lung is drained, the chest tube is removed and the opening is sutured closed and covered with a small bandage. Itching, numbness or soreness at the site of insertion is normal for a few days after the procedure.
Complications of Thoracotomy
Like all procedures, thoracotomy and chest drainage may be associated with certain complications such as:
- Tissue damage due to wrong placement of the chest tube
- Pus formation
- Injury to the lung