Chest Tube
Advertisement 1. Indications 1. Tension Pneumothorax 2. Simple Pneumothorax 3. Open Pneumothorax 4. Massive Hemothorax 2. Equipment 1. Size #34 French Chest tube (#38 F for Hemothorax) 2. Chest Tube Suction Apparatus or pleur-evac 3. Technique 1. Insertion Site 1. Level of 5th intercostal space, over 6th rib 1. Nipple level in men, inframammary fold in women 2. Insert anterior to mid-axillary line 2. Preparation 1. Betadine prep and drape 2. Lidocaine 1% local anesthetic to skin and rib 3. Insertion Procedure 1. Incise Horizontally 2-3 cm over the 6th rib 2. Bluntly dissect through subcutaneous tissue over rib 3. Carefully puncture parietal pleura with clamp tip 4. Insert finger into incision and make 360 degree sweep 1. Check for organs, adhesions and enlarge path 5. Insert chest tip with clamp 6. Look for tube condensation indicating good placement 4. Procedure Completion 1. Suture tube in place 2. Attach chest tube to suction 1. Underwater seal apparatus and suction (-20 cm H2O) 2. Pleur-evac 3. Chest XRay 1. Verify position and function of tube