- Prep the side of the chest with betadine in sterile fashion and drape it.
- Using your scalpel make an incision on the anterior axillary line at the 4th or 5th interspace
- Make the incision big enough to get your finger in going the same direction as the interspace
- Dissect bluntly with your finger down to the ribs with your finger
- When your get down to the ribs, you want to go over the rib below with your forceps
- Push through the ribs and make a whole with your forceps.
- When you get in, you should get a rush or air or blood come out of the hole
- Clamp the distal end of your tube and direct the end with the hole up towards the apex.
- Hook it up to the suction tubing and suture the chest tube in place.
- Place the petroleum gauze around the tube.
- Get a Stat portable chest after the procedure
- Chest tube (Usually 28-32 for air and 36-40 for blood)
- Adhesive tape to secure tube
- 6 foot tubing
- connectors
- Pneumovac (the suction drain)
- Sterile Towels
- Betadine
- 4 X 4 Guaze Packages
- 10 mL syringe for local anethesia
- Local Anesthetic (Usually lidocaine with or without epinephrine)
- Straight suture scissors Large
- Needle holder
- Sutures (0.0-2.0 usually silk or nylon)
- Forceps
- Scalpel
- Petroleum gauze and tape
- Bleeding
- Infection
- Visceral Injury
- Intercostal nerve or vessel injury
- Air Leaks
- Subcutaneuous or Mediastinal Ephysema
- Reexpansion hypotension, hypoxia, or pulmonary edema
- Reoccurence of pneumothorax after chest tube removal.
- Pleural Adhesions, scars, blebs
- Recurrent pneumothorax that requires surgical treatment
- Need for immediate open throacotomy (loss of vital signs in trauma bay with penetrating chest trauma)
- Bleeding diathesis (INR>1.4)
- Pneumothorax (Usually >15%)
- Hemothorax
- Hemopneumothorax
- Emypema
- Draining of recurring pleural fluid
- Chlyothorax
