The LSUHSC New Orleans
Emergency Medicine Interest Group
The Student Procedure Manual
Chest Tube Placement
by Todd Howell
- Pneumothorax as visualized by Chest Radiograph
- Hemothorax as visualized by Chest Radiograph
- Sucking Chest Wounds
- Drainage of recurrent pleural effusion
- Multiple Pleural Adhesions
- Hemothorax resulting in large volume loss without adequate volume replacement available
- Any situation requiring an immediate open thoracostomy
- Sterile Thoracostomy Tray (Containing: Prep razor, sterile towels, gauze pads,
l0cc. syringe, 20cc. syringe, 25 ga. 5/8 inch needle, 23 ga. 1 1/2 inch needle,
basin for prep solution, cup for anesthetic, large straight suture scissors,
large curved Mayo scissors, large & medium Kelly clamps, needle driver,
1-0 & 0 silk sutures on cutting needles, #4 scalpel handle, #10 scalpel
- Local anesthetic (I% Xylocaine with Epinephrine)
- Prep solution (Betadine, etc.)
- Vaseline gauze
- Chest tubes (28-36 French for Adults; 16, 20, or 24 French for Child)
- Clear sterile tubing for attachment of tube to suction device
- In emergent situations, the second intercostal space in the midclavicular line
can be used as an insertion site for needle decompression, followed by immediate
- 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.
- Once the locati cement has been chosen, the area must be cleaned and sterilized.
- Using the prep razor and prep solution, remove any hair and then sterilize the
- THIS IS NOW A STERILE FIELD AND STERILE TECHNIQUE MUST BE USED!
- Fill a syringe with I % lidocaine anesthetic.
- Using the 25ga. needle, administer the anesthetic subcutaneously over a wide
area one intercostal space below the level of insertion @ 5-7 cc.
- Next switch to the 23ga. needle and use it to administer anesthetic to the deeper
tissues and parietal pleura @ 5-10 cc.
- 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
- Damage to organs or nerves
- Dislodgment of chest tube
- Incorrect tube placement
- Air leaks
- Blocked or kinked drainage/suction tubes
- Allergic reaction to prep materials or anesthetic
- Hypotension resulting from pulmonary reexpansion
- Edema resulting from pulmonary reexpansion
- Pulmonary atelectasis
- Increased blood loss during use of pleurevac
Interpretation of results
- Post procedure PA Chest X-ray taken during patient expiration to confirm tube
placement and lung reexpansion.
- A chest tube may be removed when there is no blood or air loss for 24 hours.
- Also since approximately 100cc. of pleural fluid is produced each day, a chest
tube should only be removed if fluid loss is less than 100cc. in 24 hours.
- The outer gauze pads should be removed leaving the Vaseline gauze in place.
- Hold the tube in place while cutting the sutures used to secure it, maintaining
long ends to close the thoracostomy site.
- Have the patient take a deep breath, then as they exhale REMOVE THE TUBE AS
QUICKLY AS POSSIBLE, pulling the sutures closed immediately upon exit of the
- Removal of the tube rapidly, decreases the amount of pain as well as improves
the odds that air will not enter the chest cavity.
- Leave the Vaseline dressing in place over the site for at least 48 hours before
changing it to allow the wound to heal.
- Make sure you order and check a PA chest X-ray to be sure a pneumothorax did
not result from the removal of the tube.
See also Thoracentesis
This page copyright © 1997-2002 LSUHSC EMIG. All rights reserved.