OR / Prep · Trauma & Acute Care Surgery · open
You’re scrubbing into
Intercostal chest drain insertion
Today’s patient
A 58-year-old man is still febrile on day 6 of treatment for a left lower lobe pneumonia.
Why are we operating?
A tube into the pleural space through the safe triangle, the treatment of pneumothorax, haemothorax and effusion, and the trauma bay's most performed operation.
Indication: Traumatic haemothorax or pneumothorax, tension pneumothorax after needle decompression, and large symptomatic effusions.
The operation in 4 steps
01The safe triangle
02Blunt dissection into the pleura
03Tube placement and connection
04Securing and the check film
Danger zones
Intercostal neurovascular bundle
The bundle cannot be seen from outside; only technique protects it, and a drain forced under a rib rather than over one finds the artery.
Watch it done
Chest tube placement
The emergency medicine teaching of the open technique in the triangle of safety.
Source: EM:RAP Medical Education · Watch on YouTubeChest tube placement
The Boston Children's open-access teaching, longer and slower, with the underwater seal explained.
Source: OPENPediatrics · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.