• Prolonged drainage of air or fluid (eg, empyema, hemothorax)
from the pleural space.
• Definitive treatment of a tension pneumothorax (after needle
• Sterile gloves, mask, and gown.
• Iodinated skin preparation with sterile sponges.
• Sterile towels.
• Local anesthetic (1% lidocaine without epinephrine).
• 5-mL syringe with 25-gauge needle.
• 18-gauge 2-inch needle.
• #10 scalpel with handle.
• Chest tube and Kelly clamp for large bore insertion.
• Pleurevac or other drainage system, including all connectors
necessary to connect to chest tube and to suction.
• Needle holder.
• Suture scissors.
• 2-0 silk suture.
• 4 × 4 gauze.
• Transparent occlusive dressing.
• Patient should have intravenous access.
• Oxygen should be available.
• Monitor oxygen saturation with pulse oximetry.
• Younger patients may need sedation or anesthesia for procedure,
especially with large bore chest tube insertion.
• Explain procedure in a developmentally appropriate manner before
and during procedure.
Anatomy of the neurovascular bundle.
• Use 25-gauge needle and 5-mL syringe to infiltrate
skin and make wheal under skin.
• Change needle to 18 gauge with 2-inch needle.
• Infiltrate through wheal, over top of rib, to anesthetize the periosteum,
and into pleural space.
• Be sure to aspirate first, and know when you are in the pleural
• The pleura needs to be anesthetized, but, to avoid a puncture
of the lung, do not advance the needle further.
Chest Tube by Seldinger Technique
• Remove needle (while always maintaining a hold on the guidewire).
• Make small incision at site of insertion (large enough to pass
chest tube) (Figure 21–2C).
• Starting with smallest dilator, insert dilator over guidewire
using a twisting motion (while always maintaining a hold on the
guidewire) (Figure 21–2D).
• Repeat with larger dilators over guidewire until track is large
enough to ...
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