Under certain circumstances, fluids accumulate in the body, which can endanger health. These are, for example, blood or gases that form accumulations due to accidents, operations or because of a disease. A chest tube drains the substances to the outside.
What is chest drainage?
A drain represents a tube that is a connection between the fluid accumulation as well as a collection container. The chest drain is used only for discomfort in the chest area. A drainage represents a tube that is a connection between the fluid collection as well as a collection container. While drains can in principle be placed almost anywhere in the body, chest drainage is only used for complaints in the area of the chest. In general, the term encompasses a wider range of measures for draining fluids. More commonly, however, the word chest drainage refers exclusively to pleural drainage. Here, a tube is placed between the lung pleura and the pleura. On closer inspection, the medical material is located in the pleural space, which is where its name comes from. Under certain circumstances, the drainage of fluids is also necessary in the space between the lung lobes. This area contains important organs such as the heart, trachea and esophagus. The region between the lung lobes is called the mediastinum, and the medical name for the pericardium is the heart. Depending on its location, the chest drainage can thus take on different terms: Mediastinal drainage, pericardial drainage, or pleural drainage.
Function, effect, and goals
As soon as certain substances such as blood, air, or pus accumulate in the pleural space, a chest drain becomes necessary. Otherwise, the lungs cannot expand sufficiently, which may result in severe shortness of breath, for example. If there is a large amount of fluid, arteries and veins to the heart can also become restricted. Poor blood supply has further medical consequences, because blood cells are carriers of oxygen, which all structures in the human organism need to function. The accumulation of fluids increases the pressure. Such a situation is life-threatening, but can be avoided by a chest drainage. Thus, the goals of such treatment are to drain all substances from the thorax that endanger health. Furthermore, the resulting pressure should be reduced in this way or prevented from the outset in planned situations such as an operation. There are certain diseases in which a chest drainage is necessary. These include pneumothorax and tension pneumothorax. Air can enter the pleural space due to a rib injury or as part of a surgical procedure that requires an open chest. The starting point is an injury to the lung. The condition is noticeable by shortness of breath, pain and palpitations. As soon as air enters the pleural space during inhalation but cannot escape to the outside during exhalation, a life-threatening situation may develop. For example, the equalization is obstructed by tissue that has shifted in front of the injury. In this way, the pressure can rise without restriction, so that the heart can no longer perform its function. Hematothorax is the accumulation of blood. This penetrates through injuries of the blood vessels into the lung. Thus, accidents or lung cancer can cause the rupture of the veins. Not only does pain and shortness of breath occur, but if the condition lasts longer, blood loss also increases. Rapid application of a chest tube can save the patient’s life. However, in very severe cases, additional surgery may be necessary. In pleural empyema, the physician finds pus in the pleural space. This gets into the thorax, among other things, via infections that have developed after an operation or pneumonia. In this case, a chest drain is used on the one hand to drain the fluid. On the other hand, flushing out the chest with a saline solution via the drainage helps to bring the inflammation under control.
Risks, side effects, and hazards
The benefits of chest drains cannot be overlooked. In certain situations, they are quite capable of saving the patient’s life.Nevertheless, a chest tube is not entirely risk-free. In order for the tube to be positioned correctly, the rib muscles and pleura must be opened. The lower edge of each rib is accompanied by the course of an artery, vein as well as a nerve. These structures can be injured by a thoracic drain, especially if it has to be placed under time pressure. Injury can result in bleeding, for example, and in more serious cases, in insensations resulting in numbness as soon as a nerve is restricted in its function. Furthermore, it cannot be ruled out that the tube may injure surrounding structures of the body during insertion. Because these are important organs such as the heart, aorta and trachea, the consequences can be severe. If the placement of a chest tube does not succeed without symptoms, most physicians usually proceed directly to emergency surgery. Another risk is the wound that results from the chest drainage. Bacteria or other pathogens can accumulate here and lead to infections. As soon as redness or swelling in the area of the puncture site becomes noticeable, a doctor should be alerted to the change. The same applies to a sudden larger secretion of fluids. These may indicate further bleeding and should be checked by a physician. Thus, chest drainage is not exclusively a gainful procedure. Nevertheless, in a life-threatening situation, the advantages usually outweigh the potential disadvantages.
