Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Chest Tube Insertion

United States Department of Defense

Chest Tube Insertion

1. Fluid resuscitation via a large-caliber IV and monitoring of vital signs should be in process.

2. Determine the insertion site, usually the nipple level (5th intercostal space) anterior to the midaxillary line on the affected side. A second chest tube may be required for a hemothorax.

3. Prep and drape the chest at the predetermined site of the tube insertion.

4. Locally anesthetize the skin and rib periosteum.

5. Make a 2-3 cm transverse (horizontal) incision at the predetermined site and bluntly dissect through the subcutaneous tissues, just over the top of the rib.

6. Puncture the parietal pleura with the tip of a clamp and put a gloved finger into the incision to insure that the pleural space has been entered and the area is free of adhesions.

7. Clamp the end of the thoracostomy tube and advance the thoracostomy tube into the pleural space to the desired length.

8. Look for "fogging" of the chest tube with expiration, or listen for air movement.

9. Connect the end of the thoracostomy tube to an underwater-seal apparatus or flutter valve.

10. Suture the tube in place.

11. Apply a dressing and tape the tube to the chest.

12. Obtain a chest X-ray.

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Operational Medicine 2001

Health Care in Military Settings

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