American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is an indication for performing a chest tube insertion in the operating room?

1. Less than 250 cc/hr for 3 hours

2. More than 1,500 cc after insertion

3. Stabilized bleeding rate

4. Less than 2,500 cc after 1 day

The correct answer is: More than 1,500 cc after insertion

Performing a chest tube insertion in the operating room is often indicated when there is a significant accumulation of fluid or air in the pleural space that requires immediate intervention. The indication of more than 1,500 cc after insertion is particularly critical because it suggests a substantial pleural effusion, hemothorax, or a significant air leak that could compromise respiratory function and hemodynamics. This volume indicates that the body cannot effectively manage the fluid or air accumulation, necessitating the placement of a chest tube to drain the excess and facilitate lung re-expansion. The other choices do not adequately reflect situations that typically warrant chest tube insertion. For example, a rate of less than 250 cc/hr for 3 hours indicates that drainage may be adequately managed without immediate surgical intervention. Similarly, a stabilized bleeding rate and less than 2,500 cc after 1 day could suggest that, while monitoring is necessary, invasive intervention like chest tube placement is not urgently required unless there are other complications present.