Traumatic Pneumothorax
1. What are the 6 indications for a chest tube? trauma
- Tension pneumo
- >2cm on erect CXR
- Respiratory distress or compromise
- Moderate to large haemothorax or effusion
- Empyema
- Prophylactic in aeromedical evacuation
2. Describe the placement of a chest tube procedure
- Review history/exam/indication
- Confirm imaging and side
- Obtain verbal consent (document)
- Check equipment and ICC tray, get extra pair of hands
- Position patient supine, at 45 degrees, ipsilateral arm above head
- Mark anatomy, triangle of safety (med pec, lat dorsi, nipple/IMF line)
- Sterile technique, scrub and glove and gown
- Prep and drape
- Local anaesthetic 20ml 1% lignocaine
- On the superior border of the inferior rib in the 4th or 5th ICS, make incision
- Bluntly dissect over top of lower rib with artery forceps
- Controlled puncture of the parietal pleura with blunt forceps
- Finger sweeps
- Clamp the 28fr ICC and insert without trochar
- Aim superior for PTx and inferior for HTx
- Secure with 0 silk, and suture skin tight around tube with simple interupted nylon
- Connect drain to underwater seal drain
- Secure tube to patient using sleek, and seal
- Confirm swing on drain
- Confirm position of CXR
- Dispose of sharps
- Document
3. Associated Notes