Own the Chest Tube!
aka Ruling the Resus Room 009
By now you’re all familiar with this ‘Own the whatsit!’ series. LITFL trawls the web looking for the best online video resources dealing with a particular emergency procedure or problem, pulls them all together and serves them up on a platter for general consumption.
This time round, we’re going to ‘own the chest tube!’ — as well as the chest drain and a few other things along the way…
Needle decompression
Whoa! A tension pneumothorax! We need to perform perform needle decompression of the chest quick-smart… Here’s how Michael McGonigal from The Trauma Professional’s blog does it:
Needle decompression (McGonigal)
But, hang on a sec, perhaps we shouldn’t be using that needle after all… Listen to Scott Weingart’s take on this in Needle versus Knife II: Needle vs. Finger Thoracostomy.
Intercostal catheter insertion
Now it’s time for the chest tube. Here’s Michael McGonigal again with his approach for chest tube insertion in trauma:
ICC insertion (McGonigal)
Because repetition is the key to learning, here’s another video demonstrating ICC insertion on a dummy, and connection to a Pleur-evac UWSD:
ICC insertion (Pleur-evac UWSD)
Of course, these days for pneumothoraces and pleural effusions we tend to use the Seldinger approach. Those pigtail catheters can be a bit tricky if you’re not familiar with all the parts. Check out this video demonstration of a pigtail catheter with obturator:
Pigtail catheter with obturator
Other useful online resources include:
- Ernest Wang: Cook Medical 12 French Tube Thoracostomy Insertion Video.
- NEJM’s video on tube thoracostomy (requires subscription).
Chest drains and Heimlich valves
Got the tube in, now what? Gotta connect it to something!
But first, are you sure you understand how a 3-bottle system chest drain works? (The action starts at about 40 seconds in):
Bottle 1
Bottle 2
Bottle 3
If you can bear the advertisational tone, this video shows how to setup an Atrium drain:
Chest drain removal
Don’t need that tube anymore? Michael McGonigal shows how he takes out a chest tube:
ICC removal (McGonigal)
Further Reading
- Pleural tap
- Chest drain insertion and removal
- Own the Airway
- Own the Oxygen
- Brims F. Tension pneumothorax – time to change the old mantra? LITFL
- Johnston M. Searching for Smaug. LITFL
- Brims F. Tension Pneumothorax – an alternative view. LITFL
- Rippey J. Lung ultrasound: Pneumothorax. LITFL
- Nickson C. Pneumothorax. CCC
- Top 100 CXR
CLINICAL CASES
Resus Room Reflection
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC