(6) Using the clamp, make a hole into the pleural space. Grip the clamp
along its shaft to prevent plunging too deeply into the chest. Make the hole at the top
edge of the patient's rib. Spread the clamp to enlarge the hole and remove the clamp.
(7) Explore the pleural space. With the sterile gloved index finger of your
dominant hand, explore the intrathoracic area to confirm that it is free of adhesions or
clots. Be careful to guard against extrapleural tube placement.
Insert the chest tube in this manner:
(a) Grasp the chest tube with the clamp. Beveling the end of the chest
tube with scissors to facilitate the passage of the tube through the chest wall. Remove
any sharp edges.
(b) Guide the chest tube into the pleural space.
Advance the tube to the apex, leaving no holes external to the
Air whistling in and out of the tube indicates proper intrapleural placement of
the tube but creates open pneumothorax. Therefore, the chest tube is
(9) Look for fogging of the chest tube when the patient breathes out, an
indication of a properly placed tube.
(10) Quickly attach the chest tube to an underwater seal apparatus.
If a drainage system is not available, improvise with a Heimlich valve.
(11) When the tube is properly placed, secure it with a suture attached to the
skin. Leave one suture long and tie that suture securely around the chest tube.
(12) Apply the dressing. Follow this procedure:
(a) Apply tincture of benzoin to the skin.
(b) Place petroleum gauze around the tube exit site to make an airtight
Cover the gauze with a dry, sterile dressing.
Secure the test tube with adhesive tape.
(13) When it is possible, obtain a chest x-ray to be sure the chest tube has
been placed properly.