Chest tube

14/M came in with complain of chest pain.

27/4/2009
1000H Walked in admission, accompanied by porter. Pt G/C conscious and alert. Was seen by Dr. SY in clinic. Ordered to admit and to do chest tube insertion. Called up Dr. SY about Pt has admitted to the ward. Same said will do a chest tube insertion in the ward. Obs taken, stable. NFO.#

Pt = patient
G/C = general condition
Obs = Observation
NFO = no further order


When Dr. SY came to the ward. I was so brave to ask Dr.'s permission to observe the procedure. He was very kind to allow all the students in. Beginning of the procedure, check the procedure trolley prepared, whether anything has not prepared.

Needles and syringes for Local Anaesthesia. Forceps and Scissors for cutting and holding. Blade for cutting the skin. Iodine as a antiseptic solution. Chest tube size 28 *larger diameter, less complication in clogging*, free end Chest Drainage Device (suction) to connect to the tube inserted to enable fluids, gases, blood or pus to drain out with only one direction via a valve, which prevent backflow.

1. Clean skin with Iodine solution
2. inject LA(Local Anaesthesia) to numb the area around the targeted place for chest tube
3. Cut the skin using a blade
4. Scissors to make a passage into the pleural cavity (not sure about this part)
5. Cut tube with few holes.
6. Insert to the passage.
7. Connect to a Chest Drainage Device.

When I was inside the room, standing just in front of pt 14/M, I prayed very hard that the procedure can finish smoothly. This is the first time I saw such a terrible procedure done in ward. During the LA injection, I was in mild feeling of nausea. Then making a passage through a fresh cut wound to the pleural cavity was the most terrible part.

I saw the patient's expressions, he was in pain but he kept not to shout out. I saw his mother standing behind the curtain peeping in (She cried after the procedure). When making a passage, Dr. tried very hard to pook through something, Dr. pull out scissors and insert back again for few times and finally a sound 'Pop'. Dr. has pooked through something (I'm not sure what is it, a intercostal muscle or something) Then insert the chest tube.

I felt very very bad to show unstable body movements like playing fingers in front of pt. My stomach was acidic, I felt throwing up. My back spine got a severe cold feeling from the sacral region until cervicle region, I was slight sweating and I feel lack of Oxygen supply to my brain. I'm about to faint. I hardly make a move to take a deep breath outside the room. My legs were difficult to move. When I was outside. I breathed like I got an Asthma attack, sweating like fountain.

I quickly ran to the toilet when I was able to move. I saw redness on my face, I was totally unable to control my emotion. I waited until I'm okay, I walked out and started to work again. I had a slight affected performance after the procedure. I was doing not very efficiently.

I had my lunch after my work, I can't finish my meal.