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 #chesttube #placement #checklist #procedure #instructions #supplies #pulmonary
