Remerand et al evaluated chest tubes for appropriate positioning in critically ill patients. The authors are from the University Pierre et Marie Curie in Paris, France.


Ideally the chest tube should run in the pleural space between the parietal and visceral pleura with the openings unobstructed.


Locations of a malpositioned chest tube:

(1) within a lung fissure

(2) intraparenchymal (into lung tissue)

(3) between the chest wall and parietal pleura


Malpositioned tubes have a higher rate of being kinked than properly placed tubes.


Complications of a malpositioned tube:

(1) erosion into a bronchiole

(2) injury to a branch of the right pulmonary artery

(3) inefficient drainage

(4) bronchopleural fistula

(5) empyema or lung abscess

(6) hemothorax


The primary risk factor for chest tube malposition was use of a short trocar during insertion rather than by blunt dissection.


Reasons why the diagnosis is not made:

(1) A routine AP chest X-ray may not detect a misplaced tube.

(2) The radiologist may not evaluate tube placement.

(3) No imaging studies are done.


It is important that the radiologist be asked to report on chest tube placement any time that a chest CT scan is done.


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