Surgical Chest Tube for Unstable Pneumothorax or Hemothorax

PREPARE

 • Landmark: Anterior Axillary Line, 4th or 5th intercostal space

 • Clean: Chlorhexidine, Sterile gloves & drapes.

 • Freeze: Lidocaine: freeze skin, then down to rib.

PLACE

 • 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.

SECURE

 • 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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