Easily place a chest tube (tube thoracostomy) no matter the situation! Patients with pneumothorax or fluid in the chest (pleural effusion, hemothorax, empyema) may benefit from chest tubes. If you like this content, be sure to check out the other videos in this PROCEDURES SERIES!

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Intro: (0:00)
Gathering Supplies: (0:24)
Preparation and Positioning: (2:25)
Procedural Steps: (5:19)
Outro: (10:05)

Supplies you should gather:
Mayo stand
Knife (15 blade preferred)
Chest tube (consider 28F for general purposes)
Water seal / suction chamber (i.e. Atrium or Pleur-Evac)
2x pairs of Kelly clamps (or similar)
Gauze
Suture and needle drivers
Sterilizing prep (i.e. chlorhexidine) and drape (consider thyroid drape)
Local anesthesia and syringe with needles

Preparation Tips and Tricks:
Position the bed flat and elevated to your working height
Slide the patient to the edge you are working on
Open your equipment in a sterile fashion; consider how much help you have
Don't forget to set up the Atrium including the water seal chamber
Clamp the extracorporeal end of the chest tube

Key Steps of the Procedure:
Infiltrate local anesthesia
Make 2-3 cm incision in the 4th or 5th intercostal space at the midaxillary line
Use Kellys to navigate above the rib and punch through the parietal pleura
Spread the tract generously, then perform a finger sweep
Guide chest tube into the pleural cavity with the Kellys
Suture the chest tube in place and dress it
Hook up the chest tube to the Atrium, apply suction, and get a chest x-ray.

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Please watch: "How to Do a Central Line (Central Venous Catheter) - Behind the Knife - Bedside Procedures Episode 2 "
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