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LEARNING OBJECTIVES
1.
To know the indications and contra-indications of
CTTD
LIFE SAVING PROCEDURE: CLOSED
THORACOSTOMY TUBE DRAINAGE (CTTD) INSERTION AND ITS MANAGEMENT
2.
Develop competence in CTTD insertion
3.
Knowledge and prevention of complications of CTTD
insertion
4.
Effective management of drainage system
5.
Develop competence in removal of chest tube
DR P.O. ADEOYE
Senior Lecturer/Consultant Thoracic & Cardiovascular Surgeon, College of Health
Sciences, University of Ilorin/University of Ilorin Teaching Hospital
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MODALITIES
UITH BSS course
INTRODUCTION
 Insertion of a tube (chest catheter) through the rib
1.
Overview of CTTD
2.
Audiovisual demonstration of CTTD insertion
3.
Audiovisual demonstration of chest tube removal
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space into the pleural cavity which is connected to a
drainage device
 There is no exposure to the atmosphere through the
conduit
 It is the most common procedure performed in a
Cardiothoracic surgical service
 Crosswell Hewitt is credited as being the first to use
a chest drain, in 1876
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THE IDEAL CHEST TUBE
INDICATIONS
 Chest trauma with associated haemo or puenumo-
thorax
 Nontoxic
 Non-thrombogenic
 Soft but with thick resilient walls
 Pleural fluid collection of various aetiology
 Silastic, Polyvinylchloride
 Pneumothorax from causes other than trauma
 Post-operative following most cardiothoracic
operations
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CONTRAINDICATIONS
MECHANISM OF DRAINAGE
 Coagulopathy
1.
Gravity

 Pulmonary bullae
 Pulmonary, pleural, or thoracic adhesions
2.
Expiratory positive pressure from the patient

 Loculated pleural effusion or empyema
3.
 Skin infection over the chest tube insertion site
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push air and fluid out of the chest (e.g. cough, Valsalva
maneuver)
Suction

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as long as the chest drainage system is placed below the
level of the patient’s chest
improve the speed at which air and fluid are pulled from
the chest
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PROCEDURE
PROCEDURE
 Preparation
 Preparation
 Procedure
Position
Scrub & drape
 Site & estimation
 Anaesthesia
 Access & placement

 Procedure

 Post-operative monitoring
 Post-operative monitoring
 Complications
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 Complications
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PROCEDURE
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PROCEDURE
 Preparation
 Preparation
 Procedure
 Procedure
Position
 Scrub & drape
 Site & estimation
 Anaesthesia
 Access & placement

Position
Scrub & drape
 Site & estimation
 Anaesthesia
 Access & placement


 Post-operative monitoring
 Post-operative monitoring
 Complications
 Complications
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COMPLICATIONS:
PROCEDURE
20% malposition; 14% empyema
1.
 Preparation
2.
 Procedure
3.
 Post-operative monitoring
4.
5.
6.
 Complications
7.
8.
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Trauma to intercostal neurovascular
bundle
Extra-pleural placement
Correct positioning: Forceless, Foggy,
Fluctuation
Intra-fissural placement
Intra-pulmonary placement
Mediastinal impingement or penetration
Trans-diaphragmatic placement
Infection
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CARE OF THE CTTD
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CARE OF THE CTTD
 Ensure dependent drainage
 Observe volume and character of
 Avoid kinks or obstruction
drainage
 Avoid tube distraction or
 Confirm under-water placement of
dislodgement
drainage stem
 Protect under-water-seal
 Do not occlude the vent!!
drainage bottle
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CARE OF THE CTTD
 Tube may be clamped when moving a
patient with fluid collection but NEVER
for a patient with pneumothorax
 Assess for tube patency
 Regular milking of tube
THANK YOU
 Ambulation is advised when feasible
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