THORACOSTOMY Flashcards
THORACOSTOMY: CHEST TUBE
10 blade scalpel
INDICATION
Hemothorax
Traumatic Pneumothorax with large prenchymal or bronchial lung injury (bronchopleural or alveolar-pleural fistula)
Tension pneumothorax after a finger thoracostomy
EQUIPMENT
Personal protective equipment (sterile gloves, mask, bouffant, gown)
Lidocaine 1% with epinephrine
10-mL syringes
Needles (18G to draw, 22-25G to inject, long finder needle)
Topical antiseptic
2 large and 1 medium Kelly clamps
20-32 French chest tube
Needle driver
0 silk suture
Petroleum gauze, 4×4 in. dry gauze
Chest tube tape
METHOD
Identify the “triangle of safety.”
antiseptic, sterile drapes
Landmark fourth/fifth intercostal space (above the nipple line in males and the inframammary fold in females) along the anterior axillary line.
Inject lidocaine 1% with epinephrine
into the subcutaneous tissues until bone is encountered. March the needle cephalad until it is over a rib, and advance the needle into the pleural space.
Inject lidocaine 1% with epinephrine 10 mL into the pleural space and subcutaneous tissues as the needle is withdrawn.
Clamp the distal end and proximal end of the chest tube with a Kelly clamp
.
3- to 4-cm incision with a #10 blade parallel to the rib.
Bluntly dissect with a Kelly clamp through the subcutaneous tissues until the intercostal muscles are reached.
Bluntly dissect to enlarge the opening.
Probe and sweep 360° with gloved finger
While keeping the finger in the opening, insert the chest tube along the finger and past the last drainage hole, angled posteriorly towards the lung’s apex (pneumothorax) or base (hemothorax).
Suture and secure the chest tube into place.
Connect the tube to the chest drainage system.
Cover the insertion site with a petroleum dressing, dry gauze, and chest tube tape.
Tape the tube to the skin at a second point to create a “leash” and to prevent dislodging.
PIGTAIL
INDICATION
Most pneumothoraces
Small hemothorax
Pleural effusion
Empyema
EQUIPMENT
Personal protective equipment (sterile gloves, mask, bouffant, gown)
Lidocaine 1% with epinephrine
10-mL syringes
Needles (18G to draw, 22-25G to inject, long finder needle)
Topical antiseptic
8-14 French catheter chest tube kit
Needle driver
0 to 2-0 silk suture
4×4 in. dry gauze
Clear adhesive dressing
Chest drainage system or Heimlich valve
Ultrasound with appropriate probe
Sterile ultrasound probe cover
OR
14 F Pig Tail Catheter for pneumothorax
Ipsilateral arm extended overhead and flexed at elbow
Prep and Drape lateral chest wall, include nipple in the intraoperative field
Identify 4th or 5th intercostal space anterior midaxillary line
Inject site with local anesthetic
Incision just above the rib
Puncture pleura with Kelly clamp
Advance tube, look for fogging
Wrap with xeroform
Precut gauze
