Prepackaged chest tube tray (sterile towels, 4 × 4 gauze pads, 3–0 silk suture, curved hemostats, a no. 11 or 15 scalpel, scissors, a needle holder, antiseptic solution, antibiotic ointment, 1% lidocaine, 3-mL syringe, 25-gauge needle); sterile gloves, mask, eye protection, hat, gown, suction-drainage system (eg, the Pleur-Evac system). A high-intensity fiber optic light for transillumination is helpful (see Chapter 40). Chest tube types and sizes are as follows:
Standard (traditional) chest tube insertion. Requires a skin incision with blunt chest wall dissection and sutures. Use polyvinyl chloride (PVC) chest tubes 8, 10, or 12F. Recommended size for weight: 8 or 10F <2000 g, 12F >2000 g.
Percutaneous chest tube with pigtail catheter. Does not require a skin incision. The pigtail catheter is inserted through a needle. This is an easier and less invasive technique requiring less anesthesia. Disadvantages are that the catheter may kink and become obstructed since they are softer. It may not drain a pneumothorax with an ongoing air leak. Pigtail catheter sizes range from 5F to 12F with 8 and 10F most commonly used.