title: Does chest tube location matter? An analysis of chest tube position and the need for secondary interventions.
abstract: BACKGROUND
  Tube thoracostomy is a common procedure used in the management of thoracic trauma. Traditional teaching suggests that chest tubes should be directed in specific locations to improve function. Common examples include anterior and superior placement for pneumothorax, inferior and posterior placement for hemothorax, and avoidance of the pulmonary fissure. The purpose of this study was to examine the effect of specific chest tube position on subsequent chest tube function.
  
  
  METHODS
  A retrospective review of all patients undergoing tube thoracostomy for trauma from January 1, 2010, to September 30, 2012, was performed. Only patients undergoing computed tomography scans following chest tube insertion were included so that positioning could be accurately determined. Rib space insertion level and positioning of the tube relative to the lung parenchyma were recorded. The duration of chest tube drainage and the need for secondary interventions were determined and compared for tubes in different rib spaces and locations. For purposes of comparison, tubes placed above the sixth rib space were considered "high," and those at or below it were considered "low."
  
  
  RESULTS
  A total of 291 patients met criteria for inclusion. Forty-eight patients (16.5%) required secondary intervention. Neither high chest tube placement nor chest tube location relative to lung parenchyma was associated with an increased need for secondary interventions. On multivariate analysis, only chest Abbreviated Injury Scale (AIS) scores, mechanism, and volume of hemothorax were found to be significant risk factors for the need for secondary interventions.
  
  
  CONCLUSIONS
  Chest tube location does not influence the need for secondary interventions as long as the tube resides in the pleural space. The severity of chest injury is the most important factor influencing outcome in patients undergoing tube thoracostomy for trauma. Tube thoracostomy technique should focus on safe insertion within the pleural space and not on achieving a specific tube location.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Benns
authors.forename: Michael E
authors.initials: ME
authors.lastname: Egger
authors.forename: Brian G
authors.initials: BG
authors.lastname: Harbrecht
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.forename: Keith R
authors.initials: KR
authors.lastname: Miller
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Nash
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000628:therapy*; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed