Thoracic Lavage
From Guide to YKHC Medical Practices
Two tube technique:
- Place two bilateral 32-36F thoracostomy tubes.
- First tube small gauge (pigtail-28F) in anterior space (2nd intercostal midclavicular). A Wayne pigtail catheter (14 Fr) or a Safe-T-Centesis catheter (8 Fr) can hook directly to standard IV tubing.
- Second tube large gauge (32-36F) in posterior lateral space (5th intercostal posterior axillary line).
- Place pleuravac to lower chest tube.
- Run warmed (40-45 degree) NS at rate of 1-3 L / hr.
- Ensure same amount of fluid draining, otherwise you will cause a tension hydrothorax.
Single tube technique:
- Insert bilateral 32-36F thoracostomy tubes in posterior lateral spaces.
- Insert 14 gauge needle with stopcock into chest tube, close to chest wall. Secure with waterproof dressing e.g. tegaderm.
- Clamp tube distal to 14 gauge needle.
- Instill 300-500 mL of warmed (40-45 degrees) NS.
- After 15 minutes, drain fluid and repeat procedure.
