Surgical Chest Tube for Unstable Pneumothorax or Hemothorax
• Landmark: Anterior Axillary Line, 4th or 5th intercostal space
• Clean: Chlorhexidine, Sterile gloves & drapes.
• Freeze: Lidocaine: freeze skin, then down to rib.
• Cut & Enter:
- 3cm incision through skin + SC.
- Kellys: Blunt dissect down to rib.
- Feel superior of rib.
- Kellys: Guide over rib. Puncture into pleural space. Spread. Pull Kellys out.
- Finger: Confirm location. Sweep adhesions.
• Insert Tube: Clamp ends of tube. Insert tube into tract. Aim towards head. Advance until all fenestrations in space.
• Connect: Connect to suction, Unclamp tube
• Secure: Using 1.0 Silk, simple interrupted suture to anchor to skin, wrap repeatedly around base of tube, then tie off. Cover with dressing.
Dr. Sarah Foohey @SarahFoohey
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