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Step by step tube thoracostomy
After cleaning the surgical field local anesthetic is drawn into the syringe
By aligning the lower edge of the scapula the 5th intercostal space is identified on the anterior axillary line.
A needle is inserted by targeting the pleural space close to the upper edge of the scapula.
Drawing back slightly after entering the pleural space and obtaining air return
While withdrawing the needle, local anesthetic is gradually infiltrated into the tissue space.
Make a horizontal incision of 1.5 cm up to the subcutaneous fat.
With the clamp, create a tract from the incision site superiorly, posteriorly, and immediately above the superior edge of the 6th rib to avoid injury to the neurovascular bundle
Upon entering the pleural space, a rush of air should be heard. Then, dilate the subcutaneus tract by spreading open clamp.
Place a finger through the tract into the pleural space. Palpate the lung to confirm pleural cavity location and to assure that no adhesion are present.
Place one Kelly clamp on the distal end of the chest tube.
Grasp the proximal end of the tube in the jaws of another Kelly and insert both through the subcutaneus tract into the plural cavity. Dİrect the tube posteriorly toward the apex.
Secure the chest tube with two separate sutures. Place a horizontal matris suture around chest tube to be used and tape the untied ends of the suture around the tube to be used in closing the hole when the tube is removed.
Open the jaws and remove the proximal Kelly while advancing the tube to the predetermined position. attach the tube to the underwater seal drainage chamber and remove the distal Kelly.