Chest Tube

DOCUMENTATION

EQUIPMENT

  • Chest tube :
    • Adult: 32-40 Fr
    • Child: 20 Fr
    • Infant:12 Fr
    • Pleuravac w/ tubing
  • Chest tube tray:
  • Scalpel
  • Kelly clamps
  • Needle driver
  • Scissors
  • 0 or 1.0 silk suture
  • Tape
  • Gauze
  • Lidocaine with epinephrine
  • 20 cc syringe with needle
  • Sterile solution: Chloro-prep, iodine solution
  • Mask, gown and gloves

PROCEDURE

  • Examine the patient and assess need for placement of a thoracostomy tube.
  • Site of insertion is mid-axillary line, between 4th and 5th ribs. For men this is on a line lateral to the nipple and for women an approximation of the same line
  • Prep and drape area of insertion.
  • Position patient: Patient should place arm over head to open the ribs
  • Anesthetize area of insertion with the lidocaine. Begin with wheal and then infiltrate skin, muscle tissues, rib periosteum including the pleura
  • Make a 3-4 cm incision between the 4th and 5th ribs through skin and subcutaneous tissues parallel to the rib curvature
  • The incision should then be extended through the intercostal muscles down to the pleura
  • Insert Kelly clamp through the pleura which should be felt with a pop.
  • The clamp is opened widely in the same plane as the ribs
  • Insert finger through the incision into the thoracic cavity. Make sure the incision is in the pleura and cannot feel the liver or spleen
  • Grasp end of chest tube with the Kelly forcep and insert chest tube.
  • After tube has entered thoracic cavity, remove Kelly, and manually advance the tube in.
  • Clamp outer tube end with Kelly
  • Suture and tape tube in place
  • Attach tube to suction unit
  • Obtain post procedure chest Xray for placement; tube may need to be advanced or withdrawn

PROCEDURE NOTE

Date:

Indication: Pneumothorax/Hemothorax/Pleural Effusion

Resident:

Attending:

Patient was evaluated and required tube thoracostomy for above reason. Informed consent was obtained and a time-out was completed verifying correct patient, procedure, site, positioning. The patient was positioned appropriately for chest tube placement. The patient’s right(?)left chest was prepped and draped in sterile fashion. Lidocaine with(?)without epinephrine was(?)was not used to anesthetize the surrounding skin area. A 3 cm skin incision was made in the mid-axillary line at the level of the nipple line. Utilizing blunt dissection a subcutaneous tunnel was created adjacent to the superior rib. The pleural space was entered bluntly and gush of air(?)blood was observed. A finger was inserted into the pleural space to check for anatomy and guide tube insertion. A 32(?)36(?)40F thoracostomy tube was inserted using a Kelly clamp and positioned appropriately. The chest tube was sutured securely to the skin and a sterile dressing applied. A pleurevac was attached to the chest tube.A chest x-ray was obtained following the procedure. The patient tolerated the procedure well and there were no complications.