If air is suspected, the infant should be lying on his or. A lateral decubitus or cross-table lateral x-ray film should be done. Unless the infant's status is rapidly deteriorating, a chest radiograph should be obtained to confirm pneumothorax before the chest tube is inserted. The affected side usually appears hyperlucent (“lights up”) and radiates across the chest as compared with the unaffected side. With the room lights turned down, a strong light source is placed on the anterior chest wall above the nipple and in the axilla. Make sure the unit is below chest level when you are sitting, standing, lying down and walking. Transillumination of the chest may help detect pneumothorax but not a small pneumothorax (see Chapter 40). Keep the Pleur-evac Unit below chest level to promote drainage by gravity. For fluid collections, place the tube posteriorly and laterally. For air collections, place the tube anteriorly. Air collects in the uppermost areas of the chest, and fluid in the most dependent areas. The site of skin insertion for the elective chest tube insertion is the same for both air and fluid, but the direction of the tube is determined by examining the anteroposterior and cross-table lateral or lateral decubitus chest films for air or fluid. Pigtail catheter sizes range from 5F to 12F with 8 and 10F most commonly used. It may not drain a pneumothorax with an ongoing air leak. Disadvantages are that the catheter may kink and become obstructed since they are softer. This is an easier and less invasive technique requiring less anesthesia. The pigtail catheter is inserted through a needle. Percutaneous chest tube with pigtail catheter. Recommended size for weight: 8 or 10F 2000 g. Use polyvinyl chloride (PVC) chest tubes 8, 10, or 12F. Requires a skin incision with blunt chest wall dissection and sutures. Standard (traditional) chest tube insertion. Chest tube types and sizes are as follows: A high-intensity fiber optic light for transillumination is helpful (see Chapter 40). A chest tube is a plastic tube that is used to drain fluid or air from the chest. 11 or 15 scalpel, scissors, a needle holder, antiseptic solution, antibiotic ointment, 1% lidocaine, 3-mL syringe, 25-gauge needle) sterile gloves, mask, eye protection, hat, gown, suction-drainage system (eg, the Pleur-Evac system). Prepackaged chest tube tray (sterile towels, 4 × 4 gauze pads, 3–0 silk suture, curved hemostats, a no.
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