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Chest Tubes In Children

AMBULATORY CARE:

What you need to know about a chest tube:

A chest tube is also known as chest drain or chest drainage tube. It is a plastic tube that is put through the side of your child's chest. It uses a suction device to remove air, blood, or fluid from around your child's heart or lung. A chest tube will help your child breathe more easily.


How to prepare your child for a chest tube to be inserted:

  • If possible, help your child understand the procedure. Tell him or her why a chest tube is needed, and how it is inserted. Explain that medicine will be used to help prevent pain.
  • Your child may be given general anesthesia to keep him or her asleep and free from pain during the procedure. Your child may instead be given local anesthesia or a nerve block. He or she will be able to feel some pressure during the procedure but should not feel any pain.
  • Your child may be given antibiotics to prevent a bacterial infection. Tell your child's healthcare provider if he or she has ever had an allergic reaction to anesthesia or an antibiotic.
  • Your child's healthcare provider will tell you how to prepare your child. The provider may tell you not to let your child eat or drink anything after midnight on the day of the procedure. He or she will tell you if your child can take any of his or her medicines on the day of the procedure.

What will happen when a chest tube is inserted:

Your child's healthcare provider will make a small incision in your child's chest. A tool is used to make an opening through the chest muscle. The chest tube is inserted slowly until it reaches the pleural space or chest cavity. Your child's healthcare provider may use an ultrasound to guide him or her. When the tube is in place, it will be connected to suction and a drainage system. Stitches may be sewn into your child's chest wall to hold the tube in place. Tape may also be used to secure the tube before it is covered with a bandage.

What will happens after your child has a chest tube inserted:

  • Medicines may be given to reduce pain or prevent a bacterial infection.
  • An x-ray or a CT scan may be used to make sure the tube is in the right place. Your child may also need an x-ray after the chest tube is removed.

What you need to know about chest tube removal:

  • Your child's healthcare provider will tell you when the chest tube can be removed. After heart surgery, the chest may be removed within 72 hours. For lungs, the chest tube can be taken out when your child's lung is working normally again. One sign of this is little or no fluid draining into the chest tube. Another sign is no air leaking for 1 to 2 days. Your child may need a chest x-ray to make sure his or her lung is working as it should.
  • Your child may be given medicine to treat pain before the tube is removed. The tape will be removed. The stitches holding the tube in place will be loosened. Your child may need to breathe a certain way as the tube is taken out. Your child's healthcare provider will remove the tube. He or she may tighten the stitches to close the opening. He or she will cover the area with a bandage that will stop air from getting into your child's chest.

Risks of chest tubes in children:

Your child may get an infection, or the place where the tube goes in may bleed more than expected. Your child's organs, blood vessels, or nerves may get damaged. He or she could have chest pain after the procedure. He or she may need to have the procedure again if the tube gets pulled out. If your child's condition comes back after treatment, he or she may need another chest tube. The chest tube may not decrease your child's signs and symptoms. The healthcare provider may not be able to insert the tube. If this happens, your child may need to have another procedure or surgery.

Seek care immediately if:

  • Your child has sudden chest pain.
  • Your child has sudden trouble breathing.
  • Your child's bandage becomes soaked with blood.
  • Your child's stitches have come apart.

Contact your child's healthcare provider if:

  • Your child has a fever.
  • Your child starts to vomit.
  • Your child's pain does not go away after pain medicine has been given.
  • Your child's skin is itchy, swollen, or has a new rash.
  • The area where the tube was placed is swollen, red, or has pus coming from it.
  • You have questions or concerns about your child's condition or care.

Medicines:

Your child may need any of the following:

  • Antibiotics help fight an infection caused by bacteria.
  • Prescription pain medicine may be given. Ask your child's healthcare provider how to give this medicine safely. Some prescription pain medicines contain acetaminophen. Do not give your child other medicines that contain acetaminophen without talking to a healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your child's healthcare provider how to prevent or treat constipation.
  • Give your child's medicine as directed. Contact your child's healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency.

Care for your child:

  • Help your child find a comfortable position. Your child may have pain or discomfort while the chest tube is in. Have him or her lie in a different position to help decrease pain.
  • Have your child cough and breathe deeply as directed. This will decrease the risk for a lung infection. Have your child take deep breaths and cough 10 times each hour. Your child should hold a pillow tightly against the incision wound when he or she coughs. Tell your child to take a deep breath and hold it for as long as he or she can. Then let the air out and cough strongly.

Care for your child's chest tube:

  • Check the chest tube for kinks or loops. Keep the tube close to your child when he or she is in bed, but do not let your child lie on it. Do not let loops of tubing hang down the side of your child's bed. Be sure the tubing is long enough so that your child can move and turn in bed without pulling on it. Never clamp the tube your child.
  • Keep the suction device below the level of your child's chest. This will help fluids drain from your chest to the container below. This will also help prevent fluids from flowing back into your child's chest.
  • Make sure the chest tube is secure. Make sure the chest tube is securely taped to your child's body. The chest tube may also be taped to the suction device to help prevent the tubes from coming apart.
  • Do not turn knobs or change settings on the device unless a healthcare provider tells you to. If the suction device has water in it, the water should bubble gently, with short periods of no bubbling. A lot of bubbling that does not stop may mean air is leaking.

Wound care:

Keep your child's bandage clean and dry. Ask your child's healthcare provider when he or she can bathe.

Follow up with your child's healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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