How to place a thoracic drain

image of How to place a thoracic drain
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Image of Figure 1:
Figure 1: Have assistant pull skin 10–15 cm cranially (maintain sterile field). Ensure tension is maintained until after the tube is placed. Following tube placement, releasing the skin forms a tunnel over the tube (protects insertion site from contamination and leakage).
Image of Figure 2:
Figure 2: Make a small skin incision through the dermis/epidermis at the seventh to ninth intercostal space (be sure to incise the latissamus dorsi muscle, either at this stage or during blunt dissection).
Image of Figure 3:
Figure 3: Bluntly dissect subcutaneous tissue and underlying tissue at the cranial border of the rib to the level of the intercostal muscles (avoid the vessels and nerves along the caudal rib). Try to avoid entering the pleural space during dissection.
Image of Figure 4:
Figure 4: Place a Christmas-tree adapter with PRN/three-way stopcock at the open end of the chest tube (prevents air entering pleural space during placement). Trocar tubes (e.g. Argyl) facilitate passage through tissue – place in a gentle/controlled fashion to prevent trocar lacerating the lungs.
Image of Figure 5:
Figure 5: For non-trocar chest tubes (i.e. red rubber) use haemostats (Kelly or Halstead) to grasp the tip of the tube (align haemostats parallel to tube with the tip of the closed haemostats just beyond the tip of the tube) and push haemostats (with tube) through intercostal muscles into the pleural space. Assistant is still holding the skin.
Image of Figure 6:
Figure 6: Enter pleural space during the expiratory phase of respiration (decreases risk of lung injury).
Image of Figure 7:
Figure 7: Once in the pleural space, open haemostats and advance tube to premeasured length. Direct tube ventrally for fluid and dorsally for air. Remove haemostats without removing tube.
Image of Figure 8:
Figure 8: Release thoracic skin to create a tunnel.
Image of Figure 9A–D:
Figure 9A–D: Reinforce all connections with cerclage wire.
Image of Figure 10:
Figure 10: Purse-string and Roman Sandal suture chest tube at the skin–tube interface.


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