The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Chest Tube Placement

by Todd Howell

Indications
Contraindications
Equipment
Procedure
-Blunt Insertion
-Suturing a thoracostomy tube in place
-Removal
--Water-seal system
--Pleurevac
Complications
Interpretation of Results
Follow-up/Tube Removal
Related Tests

Indications

Contraindications

Equipment

Procedure

  1. In emergent situations, the second intercostal space in the midclavicular line can be used as an insertion site for needle decompression, followed by immediate tube thoracostomy.
  2. In most other situations, and especially for pneumothorax, a chest tube is ideally placed in the 4th or 5th intercostal space just slightly above the midaxillary line.
  3. Once the locati cement has been chosen, the area must be cleaned and sterilized.
  4. Using the prep razor and prep solution, remove any hair and then sterilize the area.
  5. THIS IS NOW A STERILE FIELD AND STERILE TECHNIQUE MUST BE USED!
  6. Fill a syringe with I % lidocaine anesthetic.
  7. Using the 25ga. needle, administer the anesthetic subcutaneously over a wide area one intercostal space below the level of insertion @ 5-7 cc.
  8. Next switch to the 23ga. needle and use it to administer anesthetic to the deeper tissues and parietal pleura @ 5-10 cc.
  9. Clamp the chest tube at a point far enough back from the tip @ 5-10 cm distal to the last lateral hole to assure appropriate length of insertion.

*A single dose of 1 gram Cefazolin may be given with no further need for antibiotic prophylaxis.

Complications

Interpretation of results

Follow-up/Tube Removal

Related Tests
See also Thoracentesis

 


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