Troubleshooting chest tube complications: How to prevent - Or quickly correct - The major problems

Chest tube insertion (CTI) is an essential part of the management of a number of conditions, such as empyema, pneumothorax, and pleural effusions. Potential complications include incorrect chest tube placement, bleeding, reexpansion pulmonary edema, sudden loss of pulse, and vasovagal symptoms. Once the chest tube is inserted, a chest film must be obtained to verify proper placement. The absence of air or fluid exiting the tube or the sudden occurrence of hemoptysis on CTI may be a sign of intrapulmonary placement, which can be catastrophic. If a patient's respiratory status worsens after CTI and you have confirmed proper placement of the tube, consider the possibility of reexpansion pulmonary edema; if this is present, limit pleural drainage to less than 1000 μL/d and limit the negative pleural pressure to -20 cm H₂O. Signals that the chest tube can be removed include fluid drainage of less than 50 μL/d and no evidence of air entering the pleural space from the lung.